Esophageal and gastric varices are dilated veins within the wall of the esophagus or stomach that protrude directly into the lumen, thus make them prone to explode and cause serious bleeding.

The problem develops when these veins acts as a collaterals for obstructed blood flow through the liver. This is mainly caused by cirrhosis, thrombosis and a parasitic infection.

Usually no specific symptoms for gastric or esophageal varices until they rupture and lead to hemorrhage. The severity of bleeding will determine the danger of the condition. The situation could be life threatening.

A number of lifestyle changes, medical procedures and medications can help prevent esophageal, gastric varices and stop blood leakage from them. If happened, Bleeding have the chance to come back with or without treatment. However, the risk is more if the condition isn’t treated properly.

Varices are abnormal dilated and swelled blood vessels that pile up blood becoming prone to explode and bleed. This problem can happen in gastrointestinal tract and commonly affects the lower portion of the esophagus and the stomach especially in patients with severe liver diseases, like cirrhosis.

Esophageal and Gastric varices form usually when blood flow to the liver is blocked. This is caused by:

• Liver cirrhosis: develops gradually from a number of liver diseases including hepatitis infection, alcoholic liver disease, and fatty liver disease.
• Thrombosis: A blood clot in the portal or splenic vein can cause esophageal varices.
• Schistosomiasis: a parasitic infection that can damage the liver, as well as the lungs, intestine and bladder.

The portal vein carries blood from several organs in the gastrointestinal tract to the liver. Then passing through circulation until end up in the heart. But when this blood doesn’t flow to the liver as should be, an elevation in the blood pressure occur in the portal vein causing portal hypertension.

This condition forces blood to find new pathways to remove congestion, so that happens through the nearby blood vessels, including those in the esophagus and stomach. These Veins begin to dilate and swell to form varices.

These veins are exposed to rupture easily because the pressure inside them is higher than the pressure inside normal veins, the walls of the varices are thin, or they are near to the surface of the esophagus.

Patients with esophageal and gastric varices usually don’t face specific symptoms until these fragile vessels rupture and GI bleeding take place, which could be noticed by: Vomiting blood, black or tarry stool or signs and symptoms of anemia, like fatigue, Lightheadedness and paleness.

In most cases, varices result from liver diseases. For that, the affected person may experience their symptoms, as jaundice, bleeding or bruising easily and accumulation of fluid in the abdominal cavity.

The physician suggests esophageal or gastric varices if patient suffer from serious liver disease. Many tests are made here to check the problem and monitoring the condition and its complications. Tests include:

• Upper endoscopy: looking for varicose veins, measure them, and check for red spots, that may indicate a greater risk of bleeding. Treatment can be done during the test.
• Imaging tests: Abdominal CT scans and Doppler ultrasounds of both splenic and portal veins can suggest the existence of varices.

The goal in treating esophageal and gastric varices is to prevent bleeding, as bleeding ones are life-threatening condition. If that happened, therapies are available to stop the blood leak. Treatment may include:

• Endoscopic sclerotherapy: By endoscope, the doctor will inject a drug into dilated veins cause them to shrink.
• Endoscopic ligation: using an endoscope to knot the affected veins with an elastic band so they can’t bleed. The bands will be removed after a few days.
• Drugs for portal hypertension: some drugs, like Beta blockers may ordered to reduce blood pressure in portal vein; thus preventing worsening of the condition and the risk of bleeding.
• Transjugular intrahepatic portosystemic shunt (TIPS): a procedure to create a “detour” of the blood flow in your liver in order to decrease pressure in the veins and the risks of recurrent bleeding. However, this procedure has serious complications, as liver failure, so it is used for temporary approaches or after burnout all other choices.
• Medications to decrease the rate of blood flow into the portal vein: Using specific drugs with endoscopy to slow the flow of blood from internal organs to the portal vein, which may help healing the veins. These include Octreotide and Vasopressin.

Explosion of varices with the subsequent bleeding is a major complication of esophageal varices and the underlying illnesses. This is accompanied by high mortality rates. Variceal hemorrhage is the most common fatal complication of cirrhosis, and form 10-30% of all cases of upper GI bleeding.

Loosing high amount of blood can lead to sharp decrease in blood pressure. thus, no enough blood supply reaches the essential organs, which may result in comma or even death if no fast interventions took place.

The best way to prevent esophageal and gastric varices is to preserve normal blood flow in the liver. This could be conducted by:

• Limiting alcohol consumption: The main cause of cirrhosis is alcohol abuse. It is perfect action to stop drinking ultimately. If that looks hard, at least keep within recommended limits (less than 14 units of alcohol a week preferably spread over 3 days).
• Protection from hepatitis: liver infection with hepatitis B or hepatitis C viruses increase the risk of cirrhosis. Vaccines are available for HBV. Healthy habits, such as safe sex and abstaining from sharing needles, blades will protect from having the disease.
• Avoiding exposure to industrial chemicals that hurt the liver, such as carbon bromide, and asking the doctor before taking medications to prevent any unwanted damage.
• Undergoing schistosomiasis-preventive measures for habitant and travelers to the affected areas. These include Drinking safe water and avoiding swimming or wading in freshwater.

According to World Gastroenterology Organization, it is estimated that 30% of patients with esophageal varices will have GI bleeding in the first year after diagnosis. Bleeding have the chance to come back with or without treatment. However, the risk is more if the condition isn’t treated quickly. The attendance of regular follow-up appointments with the doctor after receiving treatment is a key to make sure that it was successful. The risk of the cases depends on the severity on underlying liver disease. If these diseases are under control, the results reflected positively on varices condition.

Although varices may form in any part along the GI tract, the most cases appear in the distal portion of the esophagus. Approximately -by the same Organization- half of cirrhosis patients will develop gastric or esophageal varices. Gastric varices are present in 5–33% of those with portal hypertension.