Varices can also develop in internal organs such as the esophagus and stomach, characterized by engorged blood vessels. The appearance of esophageal varices and venous congestion in the stomach is a result of portal hypertension. These veins drain blood from the abdominal organs into the liver, so when changes occur in the liver tissue structure due to chronic diseases or cirrhosis, blood flow from the abdominal organs to the liver is obstructed. Consequently, congestion occurs in the veins bypassing the liver, allowing blood to flow from the abdominal organs to the liver via the inferior and superior vena cava.

Esophageal varices are a sign of venous congestion in the esophagus resulting from obstruction in blood flow to the liver. Instead of draining blood from the spleen to the liver, blood flows through the esophageal veins to the superior vena cava. The more severe the liver disease, the greater the congestion of the esophageal veins. Congestion may also occur in other parts of the intestines.

Symptoms of Esophageal Varices

Esophageal varices typically do not cause symptoms unless they bleed. Signs and symptoms of bleeding from esophageal varices include:

Vomiting large amounts of blood.

Black or bloody stools.

Dizziness.

Loss of consciousness in severe cases. Your doctor may suspect the presence of esophageal varices if you show signs of liver disease, including:

Yellowing of your skin and eyes.

Easy bruising or bleeding.

Fluid buildup in the abdomen.

Causes and Risk Factors of Esophageal Varices

Here are the key causes and risk factors:

1. Causes of Esophageal Varices Major causes include:

Severe liver scarring (Cirrhosis): Various liver diseases such as hepatitis, alcoholic liver disease, fatty liver disease, and primary biliary cirrhosis can lead to cirrhosis.

Blood clot: A blood clot in the portal vein or its feeding vessels can cause esophageal varices.

Parasitic infection: Schistosomiasis, a parasitic infection found in parts of Africa, South America, the Caribbean, the Middle East, and East Asia, can damage the liver as well as the lungs, intestines, bladder, and other organs.

2. Risk Factors for Esophageal Varices Major risk factors include:

Increased portal vein pressure: The risk of bleeding increases with elevated pressure in the portal vein (portal hypertension).

Large varices: The larger the esophageal varices, the greater the likelihood of bleeding.

Red marks on varices: When examined with a flexible tube inserted through your throat, some varices may show long red lines or red spots, which usually indicate a high risk of bleeding.

Severe cirrhosis or liver failure: The more severe the liver disease, the higher the risk of esophageal varices bleeding.

Chronic alcohol consumption: The risk of variceal bleeding is much higher if alcohol consumption continues.

Complications of Esophageal Varices

The most serious complication of esophageal varices is bleeding. Once you experience a bleeding episode, your risk of further bleeding increases significantly. If you lose enough blood, you could go into shock, which can lead to death.

Diagnosis of Esophageal Varices

The following methods are used to diagnose esophageal varices:

1. Endoscopy An upper gastrointestinal endoscopy is the preferred method for examining esophageal varices. The doctor inserts a thin, flexible, lighted tube through your mouth into your esophagus, stomach, and the start of the small intestine. The doctor will look for dilated veins, measure them if found, and check for red lines or spots, which usually indicate a high risk of bleeding. Treatment can be administered during the examination.

2. Imaging Tests Both abdominal CT scans and ultrasound of the spleen and portal veins can indicate the presence of esophageal varices. A special ultrasound called transient elastography, which measures liver scarring, can help your doctor assess if you have portal hypertension, which may lead to esophageal varices.

3. Capsule Endoscopy In this test, you swallow a vitamin-sized capsule containing a tiny camera that captures images of the esophagus as it moves through the digestive system. This may be an option for people who are unable or unwilling to undergo an endoscopic examination.

Treatment of Esophageal Varices

Treatment options include:

1. Non-Surgical Bleeding Control To reduce the risk of bleeding in varices, patients with cirrhosis and esophageal varices are treated with the medication propranolol. This drug blocks receptors in the heart and blood vessels, reducing the amount of blood flowing to the portal system. Bleeding can be treated endoscopically by directly viewing the mucosa of the esophagus. Varices are sealed with special materials, or rubber bands may be placed around the varices to constrict and close them. These treatments can completely and permanently resolve esophageal varices. Propranolol can also prevent bleeding from the stomach, as placing a rubber band on the stomach veins can be difficult. However, an endoscope can be used to inject a substance that closes these veins.

2. Surgical Bleeding Control If bleeding from esophageal or gastric varices cannot be controlled by the methods above, surgical solutions may be considered. Vascular shunts are used to facilitate blood drainage from the abdominal organs to the heart, thereby reducing portal vein pressure and preventing further bleeding. The most common surgical procedure involves creating a shunt between the main portal vein (which carries blood from the abdominal organs to the liver) and the inferior vena cava.

Prevention of Esophageal Varices

1. Avoid Alcohol People with liver disease are often advised to stop drinking alcohol, as it stresses an already weakened liver.

2. Follow a Healthy Diet Choose a plant-based diet rich in fruits and vegetables, whole grains, and lean protein sources. Limit your intake of fatty and fried foods.

3. Maintain a Healthy Weight Excess body fat can damage the liver, as obesity is linked to an increased risk of cirrhosis-related complications. Lose weight if you are obese or overweight.

4. Use Chemicals Carefully Follow the instructions on household chemicals such as cleaning products and insect sprays. If handling chemicals, take all safety precautions, as the liver detoxifies substances from the body. Reducing the chemical load will give the liver a break.

5. Reduce Your Risk of Hepatitis Sharing needles and unprotected sex can increase the risk of hepatitis. Protect yourself by abstaining from sex or using condoms if you choose to be sexually active.