What you need to know about esophageal varices!

Have the blood vessels in your esophagus, the tube that carries food from your mouth to your stomach, become swollen and enlarged? You may not have even heard of this. But this condition, called Esophageal Varices, can be silent and suddenly become dangerous. So today, let's learn everything about it very simply, as if we were talking to a friend.

Simply put, what are esophageal varices?

Imagine, sometimes our legs have swollen, twisted veins? We call them 'varicose veins'. The same thing happens inside our gullet. The walls of these veins are very weak. So there is a high chance that blood will leak out of them, or that they will suddenly burst and bleed. This bleeding inside the body can be sudden, severe, and even life-threatening.

This condition is usually caused by increased pressure in the main blood vessel that passes through the liver and other veins connected to it (Portal Hypertension). This abnormal pressure causes the small veins in the liver to swell and become larger. This condition is often seen in people with liver disease.

How serious is this situation?

The most dangerous risk of portal vein thrombosis is bleeding . Not everyone bleeds, but about 50% of people are at risk. The higher the portal hypertension, the greater the risk of bleeding. This pressure increases with liver disease, especially cirrhosis .

People with severe cirrhosis of the liver may have other problems in addition to these veins swelling. However, the main reason for hospitalization and death is the rupture of these veins and bleeding. If you bleed once in this way, the risk of death is about 20%. Also, the bleeding can recur frequently.

What are the symptoms of this condition?

Because these veins are inside the body, they are not visible like a vein in the leg. You may not even feel them when you swallow food. In fact, they may not show any symptoms until they start bleeding .

However, if a doctor sees other symptoms that suggest you have liver disease or portal hypertension, they may suspect this as well.

Why do these veins swell? What is the cause?

As we discussed earlier, the main cause is a condition called ``Portal Hypertension.`` Let's understand this a little more simply.

Think of our liver as a big filter. The blood that comes from the food in the stomach passes through the liver, where it is cleaned and then goes to the heart. The main vein that brings this blood to the liver is called the ``Portal Vein``.

Now, if the liver is scarred and hardened due to a disease like cirrhosis , that blood can't pass through the liver easily. It's like there's a big traffic jam on a road. This causes the blood pressure inside the portal vein to increase a lot.

The body tries to compensate for this increased pressure by diverting blood through smaller vessels (smaller veins). The veins in the ureter are just such small vessels. But these small veins cannot handle the large amount of blood and pressure. As a result, they swell, become large, and can burst at any time.

The main causes of liver cirrhosis are:

• Excessive alcohol consumption.
• Fatty liver (Nonalcoholic Steatohepatitis).
• Long-standing viral hepatitis infections.
• The body's own immune system attacks the liver (Autoimmune Hepatitis).
• Other causes such as blood clots, parasitic infections (Schistosomiasis) etc.

How do you know if you have this condition?

Most of the time, you only find out about this after a doctor examines you. If you already have cirrhosis of the liver, your doctor will often recommend screening for this type of vein swelling.

The main test is the Upper Endoscopy or EGD test .

This involves inserting a thin, flexible tube with a camera attached through your mouth and examining your esophagus, stomach, and the beginning of your small intestine. This allows your doctor to clearly see if your veins are swollen, how large they are, and whether they are at risk of bleeding.

What are the treatments for this?

Fortunately, there are various treatments available to control bleeding and prevent rebleeding. The main goals of treatment are to:

• Control active bleeding if there is one.
• Preventing future bleeding.
• If possible, reduce the condition of `(Portal Hypertension)`.

1. Control bleeding (emergency)

This is a medical emergency. At the hospital, you will be given IV fluids, a blood transfusion if necessary, and an endoscopy after your condition has stabilized. There:

• Varicose Band Ligation: A small instrument is passed through the endoscope and a small rubber band is placed around the varicose vein. This stops the flow of blood to the vein and controls the bleeding.
• Medications: Medications that lower blood pressure and constrict blood vessels (Octreotide, Vasopressin) are given through a vein.

2. Preventing rebleeding

Whether there is bleeding or not, if there is a risk of bleeding, the doctor will start preventive treatment.

• Beta-blockers: This type of medication, given for high blood pressure, can reduce the risk of bleeding by about 50%.
• Band Ligation: This method is also used as a preventive measure for some people.

3. Treating the underlying cause

If the above treatments do not reduce the risk of bleeding, your doctor may suggest other methods to directly reduce the condition of ``Portal Hypertension.''

• Transjugular Intrahepatic Portal-Systemic Shunt (TIPS): This is not a surgical procedure. In this procedure, a small tube (stent) is inserted into a vein inside the liver that carries blood from the portal vein, creating a new connection, or "shortcut." This greatly reduces pressure.
• Surgery: Surgical procedures such as ``Distal Splenorenal Shunt (DSRS)`` also reduce pressure by diverting blood flow.