Esophageal varices: what they are, symptoms, causes and treatment

Esophageal varices are dilated veins in the esophagus that can bleed, causing symptoms such as bloody vomiting, dark or black stools, dizziness and weakness, putting the person’s life at risk in the most serious cases.

These varicose veins develop because of increased pressure in the liver veins, which is called portal hypertension, which can arise in the case of diseases such as liver cirrhosis or venous thrombosis. Understand better what portal hypertension is and its causes.

If esophageal varices are suspected, it is recommended to consult a gastroenterologist. The treatment of varicose veins may involve the use of medicines, such as propranolol and nadolol, placing elastic bands on the varicose veins via endoscopy and surgery, for example.

Main symptoms

The main symptoms of esophageal varices are:

• Vomiting with blood;
• Dark or black stools;
• Dizziness;
• Pale skin;
• Panting;
• Weakness.

Symptoms of esophageal varices typically appear when the varicose veins rupture, causing bleeding in the gastrointestinal tract. Therefore, it is common for people with these varicose veins not to experience other symptoms until bleeding occurs.

Bleeding from esophageal varices can put a person’s life at risk in the most serious cases. Therefore, in case of suspicion, it is recommended to go to an emergency room for evaluation and start appropriate treatment.

How to confirm the diagnosis

The diagnosis of esophageal varices is made by a general practitioner or gastroenterologist by identifying the varicose veins through digestive endoscopy, an examination carried out by introducing a thin, flexible tube through the mouth with a camera at the tip. Understand better how digestive endoscopy is performed.

If you want to make an appointment, you can find the gastroenterologist closest to you using the tool below:

Especially if liver problems are suspected, the doctor may also recommend other tests, such as blood counts, liver function tests and coagulograms, to check whether there are changes in blood clotting.

Causes of esophageal varices

The main causes of esophageal varices are:

• Liver problemsmainly cirrhosis;
• Right heart failure grave;
• Pericarditis constrictive;
• Obstruction of liver veinsdue to thrombosis, for example;
• Schistosomiasiswhich can impair blood circulation through the liver veins.

Esophageal varices arise due to increased pressure in liver veins, known as portal hypertension, which causes part of the blood to be diverted from its normal circulation, dilating the veins in the esophagus.

The most common cause of esophageal varices is cirrhosis, which can be caused by problems such as fatty liver, excessive alcohol consumption, hepatitis C or hepatitis B. See what to do to prevent hepatitis B.

How the treatment is carried out

The treatment of esophageal varices depends on the severity of the liver problem and the size of the varices:

1. Medicines

The most recommended remedies for esophageal varices are beta blockers, such as propranolol or nadolol, and splenic vasodilators, such as vasopressin or somatostatin, which act by reducing pressure in the liver veins.

Although they do not cure varicose veins, these remedies are used to prevent them from rupturing and treat bleeding if it occurs.

2. Endoscopy

It is also possible to treat esophageal varices through endoscopy, which can involve placing an elastic bandage around the varices or injecting substances that cause them to close during the examination.

3. Surgery

Surgery for varicose veins in the esophagus, called shunt hepatic, it is used mainly in the most serious cases, in which it is not possible to control the pressure within the varicose veins with medication or endoscopy alone.

Additionally, surgery may also be indicated when other options have failed to control bleeding in the esophagus.

4. Nutrition for esophageal varices

The diet for esophageal varices should be low in fat and with easily digestible proteins, such as fish, white meat or vegetables, for example, to facilitate the treatment of the liver problem. See other foods in the diet recommended for liver problems.

Furthermore, due to the presence of varicose veins, it is important to take some care with food, such as:

• Give preference to pasty foodssuch as porridge, purees or vitamins, for example;
• Chew food in small amounts every time;
• Avoid very hard foodscrunchy or dry, such as cookies, dried fruit or coconut;
• Don’t eat very hot foodsleaving to cool for about 5 minutes before eating.

These precautions associated with reducing the use of alcoholic beverages are important to avoid injuries or rupture of varicose veins and, therefore, help to reduce the risk of bleeding.