Esophageal Varices

Excerpt

Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. This happens due to portal hypertension (most commonly a result of cirrhosis), resistance to portal blood flow, and increased portal venous blood inflow. The most common fatal complication of cirrhosis is variceal rupture; the severity of liver disease correlates with the presence of varices and risk of bleeding.

The portal vein has a circulation of over 1500 ml/min of blood and if there is an obstruction, this results in elevated portal venous pressure. The response of the body to the increased venous pressure is the development of collaterals. these portosystemic collaterals divert blood from the portal venous system to the inferior and superior vena cava. At the same time, one important system is the gastroesophageal collaterals that drain into the azygos vein and lead to the development of esophageal varices. When these varices get enlarged, they rupture producing severe hemorrhage. Bleeding from esophageal varices is the third most common cause of upper GI bleeding, after duodenal and gastric ulcers.