Esophageal varices: causes, symptoms and how is the treatment

Esophageal varices occur when the blood vessels in the esophagus, which is the tube that connects the mouth to the stomach, become very dilated and can cause bleeding through the mouth. These varicose veins develop because of increased pressure in the main vein of the liver, called the portal vein, and can appear due to diseases such as liver cirrhosis or thrombosis in the liver, for example.

The symptoms of esophageal varices usually appear when the blood vessels in the esophagus rupture, which can lead to vomiting with blood and black stools. However, even if they do not yet suffer from esophageal varices, people who have liver cirrhosis and other liver problems have signs and symptoms such as a swollen belly, shortness of breath or excessive swelling of the legs.

The diagnosis of esophageal varices is confirmed through blood and imaging tests, such as upper gastrointestinal endoscopy, and the treatment indicated by the hepatologist depends on the severity of the disease, with the use of medication, surgery or liver transplantation being generally indicated in more serious cases.

Causes of esophageal varices

Esophageal varices appear when there is an obstruction of blood flow to the liver, increasing the pressure in the main vein of this organ, known as the portal vein. This increase in pressure causes the esophageal veins to dilate because of the accumulation of blood, which can cause bleeding.

This condition can be caused by several liver problems, such as excess fat, excessive and continuous use of alcohol, hepatitis C or hepatitis B, which is a disease caused by viruses and which can be transmitted by unprotected intimate contact or through the use of contaminated needles or blades. Here's what to do to prevent hepatitis B.

Main symptoms

Esophageal varices appear when the blood vessels of the esophagus rupture, which can lead to the appearance of:

• Bloody vomiting; Black or black stools; Dizziness; Pale yellowish skin; Wheezing; Weakness.

In some more serious cases, when bleeding from the mouth is very intense, the person may lose consciousness because of the loss of blood, and therefore, it is necessary to call the SAMU ambulance, on the phone 192.

However, even if a person does not yet have esophageal varices, they may have other signs and symptoms of liver problems that cause esophageal varices, such as a swollen belly, shortness of breath or excessive swelling of the legs.

How to confirm the diagnosis

The diagnosis of esophageal varices must be made by a general practitioner or hepatologist through blood tests, such as blood count, liver function tests and coagulogram, to check the time it takes for the body to stop bleeding. See what the coagulogram is for and how it is done.

Upper gastrointestinal endoscopy is an exam that is also used to confirm the diagnosis of esophageal varices and is done by introducing a thin, flexible tube with a small camera attached so that it is possible to view the wall of the esophagus and stomach. There is also another type of capsule endoscopy, in which the person swallows a small camera that takes pictures of the esophagus, but it is a little used test because it is expensive and not available in all hospitals.

Treatment options

The type of treatment used for varicose veins in the esophagus depends on the severity of the liver problem and the size of these varicose veins:

1. Remedies

The most used remedies for esophageal varices include:

• Beta-blocking drugs, such as propranolol or nadolol, which reduce heart rate and, consequently, reduce pressure within varicose veins; Splenic vasodilator remedies, such as vasopressin or somatostatin, which drastically decrease the pressure inside the varicose veins, being, therefore, more used in situations of hemorrhage.

These remedies are used to decrease the risk or to relieve bleeding in large varicose veins and, therefore, do not cure esophageal varices. Thus, the doctor can also recommend other treatment options to be used in conjunction with the drugs.

2. Endoscopy

Endoscopy for esophageal varices, in addition to helping in the diagnosis, also serves to improve the dilation of the esophageal veins, by placing an elastic bandage around the varicose veins to clot the blood at the site and reducing the risk of major bleeding.

3. Surgery

Surgery for varicose veins in the esophagus, called hepatic shunt , is used mainly in the most severe cases, in which it is not possible to control the pressure inside the varicose veins with medication alone, and can also be indicated to stop bleeding in the esophagus.

Food for esophageal varices

The food for esophageal varices must be low in fats 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 indicated for liver problems.

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

• Give preference to pasty foods, such as porridges, purees or vitamins, for example; Chew food in small quantities at a time; Avoid very hard, crunchy or dry foods, such as cookies, dried fruits or coconut; Do not eat very hot food, letting it cool down for about 5 minutes, before eating.

These precautions are important to prevent injuries or rupture of varicose veins and, therefore, help to reduce the risk of bleeding.