Curriculum · Gastroenterology
Oesophageal varices
What it is
Esophageal varices are dilated veins in the lower esophagus, caused by portal hypertension, usually due to cirrhosis or right-sided heart failure. They stand among the complications of portal hypertension together with ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatic encephalopathy, and splenomegaly with thrombocytopenia. They are dilated submucosal veins, found in 50% of patients with cirrhosis of the liver, and they usually develop as a result of portal hypertension.
How it presents
Patients are often asymptomatic until the varices rupture and bleed. Approximately 60% of patients with portal hypertension will develop varices, and of those who develop varices 25% to 30% will experience hemorrhage; up to 30% of patients with esophageal varices develop upper GI bleeds, and the bleeding is usually massive. Those who develop varices from alcohol abuse have an even higher risk of bleeding, especially with ongoing alcohol consumption. The picture then is significant hematemesis with a fast heart rate and a low blood pressure, and on examination the marks of cirrhosis: spider angiomata, palmar erythema and gynecomastia, with a low platelet count and raised transaminases on the laboratory results.