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Please add the profiles of those who have died of Esophageal Varices or had Esophageal Varices but died from some other cause.


Esophageal varices are abnormal, enlarged veins in the tube that connects the throat and stomach (esophagus). This condition occurs most often in people with serious liver diseases.

Esophageal varices develop when normal blood flow to the liver is blocked by a clot or scar tissue in the liver. To go around the blockages, blood flows into smaller blood vessels that aren't designed to carry large volumes of blood. The vessels can leak blood or even rupture, causing life-threatening bleeding.

Symptoms

Esophageal varices usually don't cause signs and symptoms unless they bleed.

  • Vomiting large amounts of blood
  • Black, tarry or bloody stools
  • Lightheadedness
  • If bleeding isn’t controlled, loss of consciousness

Causes

Esophageal varices sometimes form when blood flow to the liver is blocked, most often by scar tissue in the liver caused by liver disease. The blood flow begins to back up, increasing pressure within the large vein (portal vein) that carries blood to the liver.

This increased pressure (portal hypertension) forces the blood to seek other pathways through smaller veins, such as those in the lowest part of the esophagus. These thin-walled veins balloon with the added blood. Sometimes the veins rupture and bleed.

Causes of esophageal varices include:

  • Any type of serious liver diseases can cause esophageal varices.
    • Cirrhosis is the most common type of liver disease.
    • More than 90% of these patients will develop esophageal varices sometime in their lifetime, and about 30% will bleed.
  • Severe liver scarring (cirrhosis). A number of liver diseases — including hepatitis infection, alcoholic liver disease, fatty liver disease and a bile duct disorder called primary biliary cirrhosis — can result in cirrhosis.
  • Blood clot (thrombosis). A blood clot in the portal vein or in a vein that feeds into the portal vein (splenic vein) can cause esophageal varices.
  • Parasitic infection. Schistosomiasis is a parasitic infection found in parts of Africa, South America, the Caribbean, the Middle East and East Asia. The parasite can damage the liver, as well as the lungs, intestine, bladder and other organs.

Risk factors

Although many people with advanced liver disease develop esophageal varices, most won't have bleeding.

Risks for bleeding occurs if any of these are present:

  • High portal vein pressure. The risk of bleeding increases as the pressure in the portal vein increases (portal hypertension).
  • Large esophageal varices. The larger the esophageal varices, the more likely they are to bleed.
  • Red marks on the varices. When viewed through a thin, flexible tube (endoscope) passed down your throat, some esophageal varices show long, red streaks or red spots. These marks indicate a high risk of bleeding.
  • Severe cirrhosis or liver failure. Most often, the more severe your liver disease, the more likely esophageal varices are to bleed.
  • Continued alcohol use. Your risk of variceal bleeding is far greater if you continue to drink than if you stop, especially if your disease is alcohol related.

If you've had bleeding from esophageal varices before, you're more likely to have varices that bleed again.

  • Once there has been a bleeding episode, the risk of another bleeding episode greatly increases. If enough blood is lost, the person can go into shock, which can lead to death.
  • Excessive vomiting
  • Severe coughing bouts

Diagnosis

  • Grading of Esophageal varices:
    • Grade 1: Small varices that run straight (size < 5mm)
    • Grade 2: Varices appear beaded-like (size 5 – 9mm)
    • Grade 3: Large varices that are red colored and have tumor-like appearance (size > 9mm)
  • Endoscopic exam: A procedure called upper gastrointestinal endoscopy is the preferred method of screening for esophageal varices. The doctor inserts a thin, flexible, lighted tube (endoscope) through the mouth and into the esophagus, stomach and the beginning of the small intestine (duodenum).
    • The doctor will look for dilated veins, measure them, if found, and check for red streaks and red spots, which usually indicate a significant risk of bleeding. Treatment can be performed during the exam.
  • Imaging tests. Both abdominal CT scans and Doppler ultrasounds of the splenic and portal veins can suggest the presence of esophageal varices. An ultrasound test called transient elastography that measures scarring in the liver can help the doctor determine if there is portal hypertension, which may lead to esophageal varices.
  • Capsule endoscopy. In this test, the person swallows a vitamin-sized capsule containing a tiny camera, which takes pictures of the esophagus as it goes through the digestive tract. This might be an option for people who are unable or unwilling to have an endoscopic exam. This technology is more expensive than regular endoscopy and not as available. Capsule endoscopy can only help find esophageal varices and does not treat them.

What is the long-term prognosis (outlook) for people who have bleeding esophageal varices?

  • Bleeding esophageal varices is life-threatening condition and can be fatal in up to 50% of patients.
    • People who have had an episode of bleeding esophageal varices are at risk for bleeding again.
    • Bleeding will continue to occur if the condition isn’t treated promptly. Without treatment, bleeding esophageal varices can be fatal.
  • Treatment with variceal ligation is effective in controlling first-time bleeding episodes in about 90% of patients. However, about half of patients treated with variceal ligation will have another episode of bleeding within 1 to 2 years. Medication and lifestyle changes can help reduce the risk of recurrence (return of bleeding).
  • Liver transplant many be an option for patients who have severe cirrhosis and/or repeated episodes of bleeding varices. Liver transplant is only performed at selected centers around the country that meet very strict criteria.

Prevention

Currently, no treatment can prevent the development of esophageal varices in people with cirrhosis. While beta blocker drugs are effective in preventing bleeding in many people who have esophageal varices, they don't prevent esophageal varices from forming.

If liver disease has been diagnosed, ask the doctor about strategies to avoid liver disease complications. To keep the liver healthy:

  • Don't drink alcohol. People with liver disease are often advised to stop drinking alcohol, since the liver processes alcohol. Drinking alcohol may stress an already vulnerable liver.
  • Eat a healthy diet. Choose a plant-based diet that's full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods you eat.
  • Maintain a healthy weight. An excess amount of body fat can damage your liver. Obesity is associated with a greater risk of complications of cirrhosis. Lose weight if you are obese or overweight.
  • Use chemicals sparingly and carefully. Follow the directions on household chemicals, such as cleaning supplies and insect sprays. If you work around chemicals, follow all safety precautions. Your liver removes toxins from your body, so give it a break by limiting the amount of toxins it must process.
  • Reduce the risk of hepatitis. Sharing needles and having unprotected sex can increase your risk of hepatitis B and C. Protect yourself by abstaining from sex or using a condom if you choose to have sex. Get tested for exposure to hepatitis A, B and C, since infection can make your liver disease worse. Also ask your doctor whether you should be vaccinated for hepatitis A and hepatitis B.

Treatments for Esophageal varices:

Initially, the therapy is given to reduce blood pressure in portal veins by medications such as beta-blockers. These medications can also be used to prevent re-bleeding. Other therapies that can be used are:

  • Band Ligation: Varices are wrapped with an elastic band to prevent bleeding. If there is poor visualization with endoscope, then sclerotherapy is performed.
  • Sclerotherapy: Injection of sclerosant into (intravariceal) or adjacent (paravariceal) to varices. With the help of endoscope, sclerosant is injected into esophagus. This therapy can help to prevent bleeding from the varices.
  • Balloon Tamponade: A balloon is inserted and inflated to stop the bleeding from varices by compressing the blood vessels.
  • Transjugular Intrahepatic Portosystemic Shunt (TIPS): A new connection or shunt is created between the blood vessels in liver to decrease the blood pressure. This helps in decreasing episodes of bleeding.
  • Management of acute bleeding: In cases of bleeding from esophageal varices, the goal is to stop bleeding immediately. Interventions that are required are:
    • Blood transfusion: To maintain normal volume of blood
    • There are some medications (beta-blockers) that constrict blood vessels
    • Nasogastric intubation: A tube is inserted into nose to facilitate the passage of food and medicines into the stomach through throat
  • Once the bleeding is stopped, above mentioned procedures can be performed to prevent bleeding.

Resources & additional reading: