Diagnosing Esophageal Varices and Treatment

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Diagnosing esophageal varices is sometimes done if the patient’s doctor suspects a serious liver disease like cirrhosis. Diagnostic tests may be done once, or several times, depending on the patient’s condition. Once this condition is properly diagnosed, treatment can begin.

Diagnosis

Imaging tests may be used to diagnose this condition. Commonly used imaging tests include magnetic resonance imaging and computerized tomography. Imaging tests will help the doctor better examine the circulation in the portal vein and the patient’s liver.

An endoscopy may also be helpful. For this test, a doctor will insert an endoscope into the patient’s esophagus through the patient’s mouth. If dilated veins are present, they can be graded per their size and then examined to look for red steaks. These streaks typically means that there is a significant risk of bleeding.

Treatment

After diagnosing esophageal varices, treatment can begin. The main goal of treatment involves preventing bleeding. If bleeding occurs, it is life-threatening. There are treatments that can be done to stop bleeding if it has started.

To prevent bleeding, medications may be helpful. Beta blockers, a type of blood pressure-lowering medication, may be helpful in decreasing portal vein blood pressure, therefore, decreasing the change of bleeding. Nadolol and propranolol are commonly prescribed. Using an endoscope, a doctor can use an elastic band to tie off veins or to inject a medication to prevent bleeding in high-risk patients.

If bleeding has already began, there are several treatments for esophageal varices that can be done to stop it. Using an elastic band to tie off a vein, known as variceal ligation, a doctor goes in with an endoscope, and once the vein is tied off it is no longer able to bleed. Bleeding varices can be injected, during endoscopic injection therapy, with a solution that causes them to shrink.

There are medications that can be used to slow how quickly the blood flows into the portal vein. This decreases pressure within the vein. A medication known as Sandostatin is most often used along with endoscopic therapy to treat any bleeding that is occurring. After a bleeding episode, this medication is typically used for five days.

Using a transjugular intrahepatic portosystemic shunt, the doctor will work to divert blood from flowing away from the portal vein. This is done by placing the shunt between the hepatic vein and the portal vein. This shunt is often helpful in controlling the bleeding. If the liver is severely diseased, a liver transplant may be necessary.

Resources

University of Illinois Medical Center at Chicago. (2006). Bleeding Esophageal Varices. Retrieved on November 21, 2010 from the University of Illinois Medical Center at Chicago: https://uimc.discoveryhospital.com/main.php?id=192

MedlinePlus. (2010). Bleeding Esophageal Varices. Retrieved on November 21, 2010 from MedlinePlus: https://www.nlm.nih.gov/medlineplus/ency/article/000268.htm