Are you aware of Gastric Varices? Let's talk about this!

Have you ever heard of a condition called gastric varices? You may have heard this term when you went to see a doctor because of a stomach ache or digestive problem. It can be a serious condition, so it is important to know exactly what it is. So, today we will talk about this condition called `(Gastric Varices)` in a simple way, so that you can understand it.

What are Gastric Varices? Let's understand it simply!

Simply put, Gastric Varices are swollen and enlarged blood vessels in the lining of your stomach. They can look like small balloons. This is a serious condition because if these swollen veins burst, they can cause life-threatening bleeding in your upper stomach.

You may have heard of esophageal varices, which are swollen veins in the esophagus. Gastric varices are a slightly less common condition. However, if gastric varices bleed, they are usually more serious than esophageal varices.

Think about it this way. Your stomach has a network of small blood vessels that carry blood. Normally, blood flows through these vessels without any problems. However, sometimes a major blockage occurs in the main blood vessel that carries blood to the liver. This can be caused by a condition called cirrhosis, which causes scarring of the liver. Then, there is a big ``traffic jam`` on that main vessel, meaning the pressure inside the blood vessels increases. Due to this increased pressure, the blood starts looking for other, smaller, shorter routes. Since these small veins (called varices) in the walls of the stomach are not designed to carry such a large amount of blood, they swell, bulge, and protrude. This condition is called gastric varices. If this pressure is not controlled, these swollen veins can burst.

What are the main types of gastric varices?

Gastric varices are mainly classified based on whether or not they are related to your esophagus.

Varicose veins related to the esophagus

• Type 1 Gastroesophageal Varices (GOV1): These types of varices start near your esophagus. They then extend along the "upper" (lesser curvature) of your stomach. Think of them as a side road that starts at the junction with the esophagus and runs down the left side of your stomach. This is the most common type.
• Type 2 Gastroesophageal Varices (GOV2): These also start near the esophagus. However, they extend along the "greater curvature" of the stomach. Although they start near the esophagus as before, these side paths run along the right side of the stomach.

Varicose veins not related to the esophagus

• Type 1 Isolated Gastric Varix (IGV1): This type of varix is ​​confined to the stomach. It is a swelling and bulging of the fundus, the round part of the stomach at the top.
• Type 2 Isolated Gastric Varix (IGV2): This type can be swollen anywhere in the stomach wall, not just in the fundus.

What are the symptoms of gastric varices?

Most of the time, gastric varices don't cause any symptoms. However, the problem starts when they burst and start bleeding. Then, severe symptoms can suddenly appear. At such times, you may see symptoms like:

• Vomiting dark red blood.
• Black, tarry stools (this is caused by blood mixing with stomach acids, turning the stool black)
• Sometimes there is dark red blood in the stool.
• Feeling dizzy.
• Heart palpitations.
• You may lose consciousness.
• Sudden drop in blood pressure.
• Nausea and vomiting.
• Going into shock.
• Feeling of weakness and lifelessness.

If you have any of these symptoms, it is essential to seek medical advice immediately, as this could be an emergency.

What are the main causes of gastric varices?

The main cause of gastric varices is a liver disease called `(Cirrhosis). In cirrhosis, liver cells are damaged and replaced with scar tissue. This scarring obstructs the flow of blood through the liver. Due to this obstruction, the pressure in the `(Portal Vein),` which is the main vein that brings blood to the liver, increases excessively. This condition is called `(Portal Hypertension) .` When the pressure increases like this, the blood pushes back and tries to pass through other smaller veins. Since the veins in the stomach wall are also small veins, they cannot withstand this increased pressure and swell and become varicose.

In addition to cirrhosis, there are other causes that can cause portal hypertension and lead to gastric varices:

• Blood Clot Blockage in the Portal Vein or Splenic Vein: This, like cirrhosis, obstructs blood flow.
• Parasitic Infections: An example is a parasitic infection called Schistosomiasis. This is found in parts of Africa, South America, the Caribbean, the Middle East, and East Asia. This infection can damage the liver and spleen and cause Portal Hypertension.
• Other causes other than cirrhosis: In rare cases, portal hypertension and gastric varices can occur without cirrhosis. An example is a condition called Budd-Chiari syndrome, which is a blockage of the veins that carry blood out of the liver.

What are the possible complications of gastric varices?

The most dangerous complication of gastric varices is bleeding . These swollen blood vessels in the stomach wall are very delicate. When pressure increases, they can easily burst. If this happens, a large amount of blood can suddenly leak out of the body, which can even be life-threatening. Bleeding from gastric varices is a medical emergency.

Very rarely, untreated gastric varices can cause other complications, such as:

• Iron-deficiency anemia: Gradually, over time, when blood loss decreases, the amount of iron in the body decreases, leading to symptoms such as fatigue and paleness.
• Hepatic encephalopathy: This is when the liver does not function properly, causing toxins to accumulate in the blood and affect the brain. This can cause conditions such as memory loss and confusion.

How to diagnose gastric varices?

Endoscopy and other imaging tests are mainly used to diagnose gastric varices. These tests may include:

• Upper Endoscopy: This is the best and most important way to diagnose gastric varices. This involves inserting a thin, flexible tube with a camera attached down your throat and examining the inside walls of your esophagus and stomach. The doctor can then see if there are any varices, and their size, color, and location.
• Abdominal CT scan: This can provide detailed images of your liver, spleen, and blood vessels in your abdomen. Although it cannot directly see varicose veins, it can identify symptoms related to the condition ``Portal Hypertension.'' This means that you may be at increased risk of developing varicose veins.
• Doppler Ultrasound: This test uses sound waves to examine the blood flow pattern in your portal vein and other blood vessels in your abdomen. If there are abnormalities in the blood flow pattern, it can indicate a condition called portal hypertension.

How are stomach varicose veins treated?

The treatment of gastric varices depends on whether the varices are ruptured and bleeding, or have not yet ruptured.

Treatment for unruptured gastric varices

The main goal is to prevent bleeding. Your doctor may prescribe certain medications, such as nonselective beta-blockers . These medications lower the blood pressure in the portal vein, reducing the risk of varicose veins bursting.

Your doctor may also suggest some endoscopic procedures, which can either directly seal off the varicose veins or cause them to shrink.

• Endoscopic Varicose Ligation (EVL): In this procedure, the doctor uses an endoscope to place small rubber bands around the swollen varicose veins. This stops the blood from flowing to the varicose veins and causes them to gradually shrink.
• Endoscopic Cyanoacrylate Injection: In this procedure, the doctor injects a special glue-like substance into the varicose vein. This seals the vein from the inside and stops the bleeding.

Treatment for bleeding gastric varices

This is a medical emergency. The bleeding must be stopped immediately and any complications that may arise must be prevented. Treatment options include:

• Hospitalization and Blood Transfusion: You will likely be kept in the intensive care unit (ICU) and monitored closely while receiving a blood transfusion to replace the blood lost.
• Endoscopic treatment: As well as being used for unruptured varicose veins, endoscopic treatments such as `(EVL)` or `(Cyanoacrylate Injection)` are also used to stop bleeding.
• Medications: Medications such as Vasopressin or Octreotide can help control bleeding by reducing the flow of blood to the varicose veins.
• Other ways to control pressure:
• Balloon Tamponade: In this, a special balloon is inserted into your esophagus and inflated, putting direct pressure on the bleeding varices. This is a temporary method used to control bleeding.
• Transjugular Intrahepatic Portosystemic Shunt (TIPS): This is a slightly more complicated procedure. It involves creating a new, shorter route for blood to flow through your liver. This allows blood to flow directly from the portal vein to the main vein in your liver. This allows the blood to bypass the blockage, reducing the pressure in the portal vein. This also reduces the pressure on the varicose veins, which helps control bleeding.

What is the life expectancy of someone with gastric varices?

The survival rate of someone with gastric varices depends on several factors:

• Whether they are bleeding: Bleeding from gastric varices is a serious complication, significantly reducing life expectancy.
• Severity of underlying liver disease: The prognosis is generally not as good for those with more severe liver disease.
• Treatment success: Early diagnosis and successful treatment can significantly increase life expectancy.

If you have any concerns or doubts about gastric varices or their risk factors, it's best to talk to a doctor. That way, you can get a more accurate picture of your situation.

Can gastric varices be prevented?

It may be difficult to completely prevent gastric varices. However, there are things you can do to reduce your risk, especially if you have a medical condition that causes portal hypertension. Here are some things you can do:

Control your underlying medical condition.

If you have a medical condition like `(Cirrhosis)` or `(Schistosomiasis)`, it is essential to follow the treatment plan your doctor gives you exactly to control the disease.

Medicines

If you already have varicose veins, medications such as beta-blockers can help reduce the risk of bleeding from them. However, these medications may not prevent new varicose veins from forming.

Lifestyle changes

You can do these things to reduce your risk of developing gastric varices:

• Avoid alcohol: Alcohol is a major cause of liver damage. It can also worsen portal hypertension.
• Eat a healthy diet: A balanced diet rich in vegetables, fruits, legumes, and whole grains (e.g., the Mediterranean diet) is very good for your liver health.
• Reduce salt intake: Eating too much salt can increase fluid retention in the body and worsen Portal Hypertension.
• Maintain a healthy weight that suits you: Excess weight also puts extra pressure on the liver.
• Get vaccinated: Doctors recommend getting vaccinated against Hepatitis A and Hepatitis B. These help protect the liver.

If you have risk factors for developing gastric varices, it's important to talk to your doctor and get regular tests, such as endoscopy, that can detect varices early. Early detection allows for early treatment and can prevent serious complications, such as bleeding.

When should I see my doctor?

If you suspect you have gastric varices, especially if you have symptoms that could indicate bleeding, don't delay seeing a doctor. Seek medical advice in the following situations:

• If you have been diagnosed with a medical condition that increases your risk of portal hypertension, such as cirrhosis or schistosomiasis: Ask your doctor if you should have an endoscopy to detect varicose veins early.
• If you have signs of bleeding from your upper digestive tract: vomiting blood, passing blood in your stool, or passing black, tarry stools.
• If you have unexplained abdominal pain or bloating: This could be a sign of `(Ascites)` (fluid accumulation in the abdomen), which is associated with `(Portal Hypertension)`.
• If you have symptoms of `(Portal Hypertension Encephalopathy)`: This means confusion, drowsiness, difficulty concentrating, and possibly coma.

Early detection and treatment of gastric varices is essential to prevent serious complications, such as bleeding. If you have any questions, concerns, or doubts about this, don't hesitate to talk to a doctor. He or she will examine your condition and recommend the most appropriate course of action.

When should I go to the Emergency Department (ETU) ?

If you have signs that your gastric varices have ruptured, go to the nearest emergency room (ETU) immediately. Bleeding from gastric varices is very serious and requires immediate medical attention.

What questions should I ask my doctor?

You can ask your doctor questions like these:

• What causes me to develop gastric varices?
• What are the treatment options for my gastric varices?
• What are the risks and side effects of treatment?
• What can I do to prevent my varicose veins from bleeding?
• What lifestyle changes can I make to improve my liver health?
• How often will I need to monitor my varicose veins?
• What is the long-term outlook for someone with gastric varices?

Finally, take-home message

Gastric varices can be a scary thing to hear. However, with proper medical care and early detection, many people with this condition can live full, active lives. The most important thing is to be aware of it early. You have already taken that important step by reading this article. There are effective treatments for this condition, and your doctor can work with you to develop the best plan to manage your varices and reduce your risk of bleeding.

Remember, you are not alone in this journey. With consistent medical care, you can take control of this condition and be confident in your health. Don't be afraid, be informed, and get the proper treatment. Then you too can stay healthy!

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