Esophageal varices areenlargementblood vessel veins in esophagus or esophagus. This condition generally occur as a resultliver disease that causes obstruction of blood flow to the portal vein.
The veins in the esophagus are one of the smaller veins that communicate with the portal vein. The portal vein itself is a large vein that functions to receive blood from organs of the digestive system, including from the esophagus, and channel it to the liver.
When blood flow to the portal vein is blocked, blood can divert to a smaller vein, such as the esophageal vein. A lot of blood flow from the portal vein can overload and cause dilation of the walls of the esophageal veins so that esophageal varices occur.
Causes of Esophageal Varices
Esophageal varices are caused by portal hypertension, which is high blood pressure in the portal vein. This condition can occur if blood flow from the portal vein to the liver is blocked. This can be triggered by several factors, namely:
- Cirrhosis or scarring of the liver which can be caused by hepatitis, excessive alcohol consumption, fatty deposits in the liver, or bile duct disorders
- Thrombosis or blood clot blocking the portal vein
- Schistosomiasis parasitic infection that can damage the liver, intestines, bladder, and lungs
In some cases, it is not known what causes portal hypertension. This condition is known as idiopathic portal hypertension.
Risk factors for esophageal varices
Some things that can increase the risk of esophageal varices are:
- Suffering from chronic hepatitis B
- Have alcohol addiction
- Suffering from fatty liver
- Have a tendency to develop blood clots
Symptoms of Esophageal Varices
Esophageal varices generally do not cause symptoms. However, doctors may suspect esophageal varices in patients who have symptoms of liver disease, such as:
- Jaundice
- Dark urine
- Accumulation of fluid in the abdomen (ascites)
- Easy bruising or bleeding
- Experiencing dilation of the veins around the navel
In some cases, esophageal varices are only known when complications occur, in the form of varicose rupture and bleeding.
When to go to the doctor
Check with your doctor if you experience the above symptoms, especially if you have a family who suffers from liver disease. Early examination is necessary to prevent complications of liver disease, including esophageal varices.
Go to the ER immediately if you experience signs of esophageal varices rupture, such as:
- Black, liquid, and sharp-smelling bowel movements
- Vomiting blood
- Fast heart rate
- pale skin
- A cold sweat
Ruptured varicose veins are potentially life threatening. Therefore, this condition must be treated immediately.
DiagnosisEsophageal Varices
To diagnose esophageal varices, the doctor will ask questions about the symptoms experienced by the patient and the patient's medical history. If you get symptoms that suggest liver disease, your doctor will usually anticipate esophageal varices, especially if cirrhosis is suspected.
Some of the methods used by doctors to diagnose esophageal varices are:
- Endoscopy, to see the esophageal veins directly by inserting a small camera tube through the mouth into the esophagus
- Capsule endoscopy, to see the condition of the veins by swallowing a capsule containing a wireless camera that will take pictures of the esophagus
- Imaging tests of the portal vein, liver, and other organs in the abdomen with a CT scan, Doppler ultrasound, or MRI, to detect portal hypertension
- Blood tests, to measure blood cell levels and check liver and kidney function
Esophageal Varicose Veins Treatment
Treatment of esophageal varices aims to reduce blood pressure in the portal vein so that bleeding does not occur in esophageal varices and overcomes if bleeding has occurred. Here is the explanation:
To prevent esophageal variceal bleeding
One of the recommended treatment methods is the administration of beta-blocking drugs, such as propranolol, to reduce pressure in the portal vein.
Another method that can be done is varicose veins binding (ligation) using a special rubber to prevent esophageal variceal bleeding. This method is performed with the help of an endoscope.
To treat esophageal variceal bleeding
If bleeding occurs, the patient should receive emergency treatment at the hospital immediately. Actions taken by doctors to treat this condition include:
- Giving drugs to slow blood flow to the portal vein, for example octreotide
- Do sclerotherapy, which is an injection of fluid that can cover bleeding in esophageal varices
- Performing ligation on bleeding varicose veins using a special rubber
- Running TIPS (transjugular intrahepatic portosystemic shunt) to divert the flow of blood in the portal vein when varicose veins do not bind to the bleeding
- Perform blood transfusions to replace wasted blood
- Give antibiotics to prevent infection
- Perform liver transplantation for patients with advanced liver disease and patients with esophageal variceal bleeding
Complications of Esophageal Varices
If not diagnosed and treated promptly, esophageal varices can rupture and cause bleeding. Rupture of esophageal varices can be characterized by:
- Vomiting blood (hematemesis) is fresh red with a large volume of blood
- Stomach ache
- Black stool with blood (melena)
- Shock from losing a lot of blood
There are a number of factors that can increase a person's risk of bleeding from esophageal varices, namely:
- Cirrhosis is severe or has reached liver failure
- Consuming alcohol, especially for people with alcohol-related liver disease
- Have you had esophageal variceal bleeding before?
When viewed from an endoscopic examination, esophageal varices that are large and have red streaks are more at risk of rupture.
In addition to complications from esophageal varices itself, complications can also occur due to the treatment of varicose veins, namely:
- Recurrent esophageal variceal bleeding
- Narrowing of the esophagus due to scar tissue after the procedure
Esophageal Varicose Prevention
Esophageal varices are difficult to prevent. The best that can be done is to treat or prevent conditions that can cause esophageal varices.
You can also lower your risk of developing esophageal varices by doing the following:
- Eat a balanced nutritious diet such as vegetables, fruit, and whole grains
- Maintain ideal body weight and body fat levels
- Do not consume alcoholic beverages
- Avoiding frequent exposure to chemicals, for example from household cleaners or insect killers
- Avoiding risk factors for hepatitis B and hepatitis C, such as unsafe sex and drug use through needles
For people with liver disease, do regular consultations with your doctor to reduce the risk of esophageal varices.
