Some people with liver problems may suddenly start bleeding from the mouth, or they may notice blood in their stools. When this happens, you really can't imagine what's going on. One of the main reasons for this condition is that the blood vessels in your esophagus , the tube through which food travels, become swollen and burst, causing bleeding . It's like varicose veins in your legs, but this happens inside your body. Today we're going to talk about this condition, which is medically known as Esophageal Varices. Don't worry, let's keep it simple.
What are these (Esophageal Varices)? Simply put…
Imagine, your esophagus is a tube that carries food from your mouth to your stomach. Inside this tube is a network of fine blood vessels. If for some reason, these blood vessels are under too much pressure, they gradually swell and start to enlarge. This is called esophageal varices.
The most dangerous thing about this is that the walls of these swollen veins are very weak. Like an overinflated balloon. So, they can easily burst and bleed . This bleeding inside the body can be sudden, severe, and potentially life-threatening.
How serious is (Esophageal Varices)?
The main and most serious risk of this condition is bleeding . Although not everyone bleeds, about 50% of people with this condition can bleed. As mentioned earlier, this risk increases as the pressure in the main blood vessel that passes through the liver, that is, (Portal Hypertension), increases. In most cases, this condition (Portal Hypertension) is caused by a chronic disease of the liver. So, as the liver disease worsens, this condition also worsens.
People with severe liver disease, i.e. cirrhosis, may have other problems besides esophageal varices . However, the main reason for hospitalization and death in people with cirrhosis is the rupture of these swollen veins. If this type of bleeding occurs, the risk of death is about 20%. Also, after bleeding once, the risk of bleeding again is high.
What are the symptoms of (Esophageal Varices)?
These swollen veins are not visible like they are in the legs. They are located inside the chest, often where the esophagus connects to the stomach. You don't feel them when you swallow. They usually don't cause any symptoms until they bleed.
However, if your doctor sees other symptoms that suggest portal hypertension or chronic liver disease, he may also suspect esophageal varices. Such symptoms include:
- Jaundice : Yellowing of the skin and eyes.
- Ascites : The accumulation of fluid in the abdomen.
- Edema : Swelling of the legs and ankles.
- Upper abdominal pain : Pain may be caused by swelling of the liver or spleen .
- Pruritus : Itching of the skin without any harm.
- Confusion (Hepatic Encephalopathy) : Inability to concentrate, loss of consciousness.
Symptoms of bleeding
If a swollen vein suddenly bursts and starts bleeding, you may not feel any immediate pain. However, you should be aware of the following signs of bleeding from the digestive tract or from the body :
| Symptoms of bleeding | This is how it happens… |
|---|---|
| Vomiting blood from the mouth | When you vomit blood, you may vomit blood that has clotted and looks like coffee grounds. But if a vein suddenly bursts, you may vomit fresh, red blood. |
| Blood in the stool | When the blood from the mouth is digested and comes out with the stool, it turns a tarry yellow or black color (melena). However, if the bleeding is very rapid, new red blood may also come out with the stool. |
| Other body features | When a lot of blood is lost from the body, the face may turn pale, and you may feel extremely tired and lifeless. Low blood pressure can also cause dizziness. |
Important: Symptoms of an Emergency (Hypovolemic Shock)
If you suddenly develop symptoms of a dangerous condition called hypovolemic shock, go to the ETU immediately! These symptoms are:
- Heart palpitations
- Increased breathing rate
- Feeling cold and sweating
- Restlessness and confusion
- Loss of consciousness
What are the causes of esophageal varices?
The main cause of this condition is a condition called Portal Hypertension , which is high blood pressure in the main blood vessel that passes through the liver (portal vein) and other veins that branch off from it.
Our bodies try to adapt to this increased pressure by directing the extra blood into smaller veins that can't handle it. Of these, the delicate veins in the anus are the ones that swell the most.
Main causes of portal hypertension
The main cause of this is cirrhosis, which is a hardening of the liver . This is caused by long-term damage to the liver. The liver cells are continuously injured ( hepatitis ), and eventually they become scar tissue. This scarring blocks the flow of blood through the liver. This does not happen all at once, but happens over many years.
Cirrhosis is the final stage of any chronic liver disease. For example:
- Alcohol-induced hepatitis
- Nonalcoholic steatohepatitis (NASH)
- Chronic viral hepatitis (like B, C)
- Autoimmune hepatitis
There are other possible causes of Portal Hypertension:
- Granulomas in the liver : These are collections of inflammatory cells that occur with various infections and inflammatory conditions. The main cause of this is a parasitic infection called Schistosomiasis, which affects about 230 million people worldwide.
- Thrombosis: If a blood clot forms in the venous system connected to the liver, blood flow can be obstructed (e.g. Budd-Chiari syndrome).
- Spleen enlargement .
- Heart disease : such as right-sided heart failure.
(Esophageal Varices) Diagnosis and Treatment
You won't know about this until a doctor examines you. If you have already been diagnosed with cirrhosis, your doctor will often recommend checking for this swelling of the veins. The main test used for this is an upper endoscopy .
What is (Upper Endoscopy)?
Upper Endoscopy , also known as an EGD test, is an examination of your upper digestive tract, which includes your esophagus, stomach, and the beginning of your small intestine (duodenum). This is done by a gastroenterologist, a doctor who specializes in diseases of the digestive system and endoscopy procedures. The endoscope is a long, thin tube with a small camera on the end. The tube is inserted through your mouth and passed down your esophagus to look directly for any swelling. If any problems are found, small instruments can be inserted through the endoscope to treat them.
What are the treatments for (Esophageal Varices)?
The main goals of treatment are to control current bleeding, prevent future bleeding, and, if possible, reduce portal hypertension.
| Treatment method | What happens to it? |
|---|---|
| Medications | Doctors give intravenous medications like Octreotide to lower blood pressure. There are also medications like Beta-blockers that you can take to stop the bleeding. |
| Varicose band ligation | As soon as the endoscope is inserted, a small rubber band is placed around the bleeding vein, or the vein that is suspected of bleeding, and tightened. This stops the bleeding. |
| Shunt Procedures | This is a bit complicated. There are two methods, TIPS and DSRS. This involves creating a new route for blood to bypass the liver. Either through surgery or X-rays, a vein in the liver is connected to another vein to relieve pressure. |
| Treating the underlying cause | The most important thing is to treat the underlying cause. That means stopping drinking alcohol, losing weight, or taking medication for an underlying condition like hepatitis C. |
Living with this situation
Your outlook depends on whether you have bleeding from your veins and how severe your liver disease is. The one-year survival rate for people with cirrhosis and bleeding is about 50%. The risk of death from a first bleed is 20%, and the risk of a second bleed, even with treatment, is as high as 60%.
Esophageal varices are a serious condition. However, if liver disease is identified early, lifestyle changes can be made to prevent the disease from getting worse, and these veins can also be prevented from becoming swollen.
Take-Home Message
- Esophageal varices are often a result of portal hypertension, a condition caused by cirrhosis of the liver .
- The main danger of this is the possibility of a blood vessel bursting and bleeding . This can be life-threatening.
- Even if you don't show any major symptoms at first, if you experience symptoms such as bleeding from the mouth, black stools, yellowing of the skin, and a swollen abdomen, see your doctor immediately .
- This is precisely what is detected and some treatments are performed through an examination called endoscopy.
- There are treatments, but the most important thing is to avoid things that damage the liver (alcohol, certain unhealthy foods) and to follow medical advice exactly .
- If you have liver disease, it is very important to have regular medical checkups to check for complications like these .
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