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Esophageal varices

**{{{Name|Esophageal varices}}}**
[[Image:{{{Image}}}\|190px\|center\|]] {{{Caption\|}}}
ICD-10	I85
ICD-O:	{{{ICDO}}}
ICD-9	{{ICD9
OMIM	}}}
MedlinePlus	}}}
eMedicine	}}}
DiseasesDB	}}}

-456.2 |

}} In medicine(gastroenterology), esophageal varices are extreme dilationsof sub-mucosal veinsin the mucosaof the esophagusin diseases featuring portal hypertension, secondary to cirrhosisprimarily.

Image:Post banding.jpg

Patients with esophageal varices have a strong tendency to develop bleeding.

Esophageal varices are diagnosed with endoscopy.

Inhaltsverzeichnis

1 Pathogenesis
2 Treatment and the role of endoscopy
3 Prevention
4 References
5 See also

Pathogenesis

The lower esophagusis a site of 'portosystemic anastamosis', meaning that venous blood flow in the portal circulation (i.e. draining into the portal vein) and the mesenteric circulation freely mix.

In situations where portal pressures increase, which are typically related to cirrhosis, there is dilation of veins in the anastamosis, leading to esophageal varices.

Varices can also form in other areas of the body, including the stomach(gastric varices), duodenum(duodenal varices), and rectum(rectal varices). Treatment of these types of varices may differ.

Treatment and the role of endoscopy

In emergency situations, the care is directed at stopping blood loss, maintaining plasma volume, correcting disorders in coagulation induced by cirrhosis, and appropriate use of antibiotics(as infection is either concomittant, or a precipitant).

Therapeutic endoscopyis considered the mainstay of urgent treatment. Two main therapeutic approaches exist:

Variceal ligation, or banding
sclerotherapy

In cases of refractory bleeding, balloon tamponademay be necessary, usually as a bridge to further endoscopy, transjugular intrahepatic portosystemic shuntor TIPS, or liver transplantation.

Prevention

Ideally, patients with known varices should receive treatment to reduce their risk of bleeding (Lebrec et al., 1981). The non-selective β-blockers(e.g., propranolol, timololor nadolol). The effectiveness of this treatment has been shown by a number of different studies (Talwalkar JA & Kamath PS, 2004).

Unfortunately, non-selective β-blockersdo not prevent the formation of esophageal varices (Groszmann RJ et al., 2005).

References

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}} Beta-Blockers to Prevent Gastroesophageal Varices in Patients with Cirrhosis{{qif

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}} Propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: a controlled study{{qif

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}} An evidence-based medicine approach to beta-blocker therapy in patients with cirrhosis{{qif

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Esophageal varices

Inhaltsverzeichnis

Pathogenesis

Treatment and the role of endoscopy

Prevention

References

See also