Gastric varices

What it is

Gastric varices are dilated submucosal veins, usually in the fundus, more in the fundus than the body, and they are often a sign of portal hypertension. Varices belong to the four causes that account for 80% of UGI bleeding: PUD, esophagogastric varices, esophagitis and Mallory-Weiss tear.

How it is diagnosed

At endoscopy the pattern of the lesion separates the causes of gastric bleeding:

• Gastric varices: dilated submucosal veins, usually in the fundus, fundus more than body; often in portal hypertension, and not on the lesser curvature.
• Dieulafoy lesion: a large caliber submucosal artery, exposed, with no ulcer, on the lesser curvature of the proximal stomach 1 to 6 cm from the GE junction, and a cause of massive, sometimes recurrent bleeding.
• Peptic ulcer: a mucosal defect with or without a visible vessel, on the lesser curvature or in the duodenum, usually with an ulcer crater.
• Gastric AV malformations: dilated tortuous vessels, usually multiple, anywhere in the stomach, and usually a cause of chronic rather than massive acute bleeding.