The oesophagus (or esophagus) is the tube that carries food from the throat to the stomach. In an adult human being, the muscular duct measures up to eight inches long. The oesophagus runs parallel behind the windpipe, heart, and in front of the spine. Before connecting to the stomach, it passes through the diaphragm.
The muscles in the esophagus play a significant role in passing the food to the stomach and holding the food inside before it turns into energy.
Among several, one of the principal complications that arise in the esophagus is the Esophageal Varices. In this condition, abnormal veins develop at the lower end of the tube. The veins are swollen or enlarged along the wall of the esophagus.
The condition usually goes undetected unless the veins bleed. Esophageal varices – a chronic disease, is manageable with proper medical support and guidance.
Esophageal varices Causes
The primary cause for esophageal varices is the malfunctioning of the liver. People who have liver cirrhosis are under constant threat to develop this condition.
The liver cleanses toxins from the body. When the blood flow to this crucial organ is restricted, it flows into the nearby vessels, increasing the supply. Because of this esophagus is one of the several organs that receive excess blood. The blood vessels in the esophagus are small and incapable of carrying surplus blood, leading to swelling up and resulting in varices.
Other contributing factors leading to varices are:
- Thrombosis or blood clot in the portal vein.
- Blockage of veins in the liver also known as Budd-Chiari syndrome
- Schistosomiasis, also known as bilharzia – a disease caused by parasitic worms.
Bleeding is the leading symptom that indicates the oesophageal varices. The rupturing of the veins results in one of the following conditions:
- vomiting of the blood – hematemesis
- tarry or black stools
- blood in the stools
The other symptoms might include:
- intense bouts of stomach pain
- pale or yellow skin
- irregular breathing
- easy bruising
- fluid building up in the abdomen region
The symptoms in extreme cases where the bleeding is severe include:
- loss of consciousness,
- a person entering the state of shock
The risk factor depends on the progression of the condition. Not everyone will start bleeding immediately after developing varices. The Esophageal varices bleed under the following conditions:
- If the patient has large esophageal varices
- If red marks are present on the esophageal varices.
- The patient develops high portal hypertension because of continuous pressure applied to the veins.
- Severe scarring of the liver or cirrhosis is the primary risk factor. As the severity increases, so do the chances of bleeding.
- Another reason for bleeding can be a bacterial infection. As the bacterial infection increases, it increases the chances of vessels rupture.
- On detection of cirrhosis and varices, if the patient continues to consume excessive alcohol use, it also increases the chances of bleeding.
- Esophageal varices can cause excessive vomiting or constipation since processing food becomes difficult.
- violent coughing spells can trigger the rupture of the veins
Correcting the underlying cause is the best way to prevent esophageal varices. A healthy diet and lifestyle to keep the body and the liver healthy is the way to avoid this chronic condition. Failing to accomplish that will cause complications and might lead to the replacement of the liver.
The following healthy measures should be part of daily lives to avoid this and any other health issue.
- Eat low sodium and high fibre diet.
- Include a lot of fruits and vegetables in your diet.
- Maintain a healthy weight
Avoid drinking alcohol as it can lead to liver damages.
- Practise safe hygiene protocols.
- Get periodic health check-ups as per your physician’s advice to avoid serious health blocks.
Esophageal varices treatment
- Treating the esophageal varices is very crucial. Without treatment, the condition can prove fatal. Regular follow-up with the doctor is a must as long as this is a chronic condition.
- Esophageal varices pathophysiology suggests that there are two ways to treat this disease.
A. Prevention from bleeding
- Once the condition is detected either via endoscopy or imaging, the primary aim is to prevent bleeding of the veins.
- If it is small esophageal varices, they control it via medications such as beta-blockers to reduce the pressure in the portal veins.
- Esophageal varices banding: If the doctors find you are prone to bleeding, they will suggest variceal banding. Esophageal banding involves pulling the varices into a chamber with the help of an endoscope and tying them off with elastic bands to avoid bleeding.
Endoscopic sclerotherapy is the process of shrinking the swollen veins using medications administered via endoscope.
B. Treating the bleeding
There is over one way to treat bleeding varices. All the preventive measures specified above can be used to stop or minimize the blood supply. In case the bleeding is severe, then the patient needs the following action:
- Trans-jugular intrahepatic portosystemic shunt (TIPS): It involves adding a shut between the portal vein and the hepatic vein to carry blood from the liver to the heart. The process relives the built-up stress on the portal veins, thus controlling the bleeding.
- Distal splenorenal shunt procedure (DSRS): The procedure involves connecting the primary vein from the spleen to the vein of the left kidney. This procedure is more invasive but controls bleeding up to 90%.
- Injecting clotting factors via blood transfusion serves the dual purpose of replenishing the lost blood and avoiding further bleeding.
- In very severe cases, replacing the liver is the only and the last option.
It is crucial to know the details of the condition and follow the doctors’ advice. Do not ignore the esophageal varices and self medicate, as it might cause complications. If you are in doubt, contact our doctors at Vydehi for more guidance and help. We are always around to facilitate, to get your health back in shape.