Materiały źródłowe

• #1 Esophageal Varices: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15429-esophageal-varices

  Esophageal varices are a direct consequence of portal hypertension, which is high blood pressure in your portal venous system. This includes the portal vein that runs through your liver and the smaller veins that branch off from it, sending blood back to your heart and into general circulation in your body. […] The most common cause is cirrhosis of the liver. Cirrhosis means scarring. This is the result of long-term, chronic liver damage. Constant inflammation (hepatitis) in your liver tissues eventually turns them into scar tissue, which blocks the flow of blood through the portal vein. This is a gradual process that usually takes decades. […] Other causes of portal hypertension include: Granulomas of the liver. Granulomas are collections of inflammatory cells that accompany various infections and inflammatory diseases. They can obstruct your portal vein as benign tumors, and theyre sometimes followed by scarring. A parasite infection called schistosomiasis, which affects 230 million people worldwide, is the most common cause of liver granulomas.

• #2 Esophageal Varices – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448078/

  Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. They form due to portal hypertension, which commonly is a result of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow. […] Causes of portal hypertension: […] Intrahepatic: Cirrhosis accounts for most cases of portal hypertension. […] Less frequent causes are schistosomiasis, massive fatty change, diseases affecting portal microcirculation as nodular regenerative hyperplasia and diffuse fibrosing granulomatous disease as sarcoidosis. […] Other rare causes of portal hypertension include: Wilson disease, Alpha-1 antitrypsin deficiency, Primary biliary cirrhosis, Tuberculosis, Constrictive pericarditis.

• #3 Esophageal Varices – PubMed

  https://pubmed.ncbi.nlm.nih.gov/28846255/

  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 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.

• #4 Esophageal Varices Imaging and Diagnosis: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/367986-overview

  Esophageal varices are submucosal distal esophageal veins, connecting the portal circulation and systemic circulation, that are dilated because of portal hypertension, most commonly because of cirrhosis, resistance to portal blood flow, and increased portal venous blood inflow. Variceal rupture is the most common fatal complication of cirrhosis. […] They are native veins that serve as collaterals to the central venous circulation when flow through the portal venous system or superior vena cava (SVC) is obstructed. […] There are 2 types of esophageal varices: downhill and uphill. Uphill varices are common and are found at the lower end of the esophagus; they extend upward and develop because of portal hypertension. Downhill varices are rare and are found at the upper esophagus; they extend downward and usually occur because of superior vena cava obstruction.

• #5 Esophageal Varices Causes and Diagnoses | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/gastroenterology/esophageal-varices/causes-and-diagnoses

  The portal vein carries blood from the esophagus to the liver. When the liver is scarred from chronic liver disease or theres a clot in the portal vein, excess blood flows into the smaller blood vessels of the esophagus. This increased blood pressure causes the veins to enlarge, becoming varices. […] With esophageal varices, blood vessels in the esophagus become abnormally enlarged. They may then rupture (burst) and bleed.

• #6 Esophageal Varices – Digestive Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/digestive-disorders/gastrointestinal-bleeding/esophageal-varices

  Esophageal varices are caused by high blood pressure in blood vessels in and around the liver (portal hypertension). […] The most common cause of portal hypertension in high-resource countries is liver scarring due to cirrhosis. […] Portal hypertension leads to the development of new veins called collateral vessels that bypass the liver. […] Development at these locations is dangerous because the vessels enlarge and become full of twists and turns and are known as varices or varicose veins. […] These enlarged varices are fragile and can rupture, causing massive gastrointestinal bleeding.

• #7 Bleeding esophageal varices Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/bleeding-esophageal-varices

  Liver cirrhosis – varices; Cryptogenic chronic liver disease – varices; End-stage liver disease – varices; Alcoholic liver disease – varices; NASH varices; Alcoholic hepatitis – varices; Metabolic dysfunction-associated steatohepatitis (MASH) varices. […] Scarring (cirrhosis) of the liver is the most common cause of esophageal varices. This scarring cuts down on blood flowing through the liver. As a result, more blood flows through the veins of the esophagus. […] Any type of long-term (chronic) liver disease can cause esophageal varices. […] Varices can also occur in the upper part of the stomach. These are called gastric varices.

• #8 Portal Hypertension: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/182098-overview

  The most common cause of portal hypertension is cirrhosis. […] Many conditions are associated with portal hypertension, with cirrhosis being the most common cause of this disorder. […] Two important factors, vascular resistance and blood flow, play a role in the development of portal hypertension. […] The initial factor in the etiology of portal hypertension is an increase in the vascular resistance to the portal blood flow. […] Liver disease that decreases the portal vascular radius produces a dramatic increase in the portal vascular resistance. […] Increased hepatic vascular resistance in cirrhosis is not only a mechanical consequence of the hepatic architectural disorder; a dynamic component also exists due to the active contraction of myofibroblasts, activated stellate cells, and vascular smooth-muscle cells of the intrahepatic veins.

• #9 Primary prevention of bleeding from esophageal varices in patients with cirrhosis – UpToDate

  https://www.uptodate.com/contents/primary-prevention-of-bleeding-from-esophageal-varices-in-patients-with-cirrhosis

  Patients with cirrhosis who develop portal hypertension (ie, increased pressure within the portal venous system) are at risk for complications, including the development of esophageal varices. When esophageal varices rupture, bleeding may be severe and life-threatening. Thus, strategies to prevent the first episode of variceal bleeding are important for such patients. […] The rationale for screening for esophageal varices is to identify patients at risk for bleeding from esophageal varices so as to prevent bleeding and improve survival in such patients. […] Esophageal varices develop when HVPG is at least 10 mmHg, whereas the risk of bleeding from esophageal varices is associated with HVPG ≥12 mmHg. […] Elevated portal pressure results from a combination of increased portal inflow, due to splanchnic arteriolar vasodilation, and elevated intrahepatic resistance to portal blood flow.

• #10 Bleeding esophageal varices: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000268.htm

  Scarring (cirrhosis) of the liver is the most common cause of esophageal varices. This scarring cuts down on blood flowing through the liver. As a result, more blood flows through the veins of the esophagus. […] Any type of long-term (chronic) liver disease can cause esophageal varices. […] Treating the causes of liver disease may prevent bleeding. Liver transplantation should be considered for some people.

• #11 Bleeding Esophageal Varices: Symptoms and Causes

  https://www.healthline.com/health/bleeding-esophageal-varices

  Bleeding esophageal varices occur when swollen veins (varices) in your lower esophagus rupture and bleed. […] The veins in your lower esophagus near the stomach can become swollen when blood flow to the liver is reduced. This may be due to scar tissue or a blood clot within the liver. […] Esophageal varices are caused by high blood pressure in the portal vein, which is also referred to as portal hypertension. […] High blood pressure in the vein causes blood to build up in nearby blood vessels, including those in your esophagus. […] Cirrhosis a severe scarring of the liver that often develops due to excessive alcohol consumption or serious infections, such as hepatitis is the most common cause of portal hypertension. […] They can also be caused by portal vein thrombosis, a condition that occurs when blood clots inside the portal vein.

• #12 Oesophageal Varices | Doctor

  https://patient.info/doctor/oesophageal-varices

  The causes of oesophageal varices are anything that can cause portal hypertension. Some examples are in the table that follows. […] In Western countries, alcoholic and viral cirrhosis are the leading causes of portal hypertension and oesophageal varices. […] Risk factors for rupture of oesophageal varices include size of varices, severity of liver disease, sepsis, and hepatocellular carcinoma. […] The majority of patients with variceal bleeding have chronic liver disease.

• #13 Understanding Esophageal Varices: Causes, Symptoms, and Treatment | Medanta

  https://www.medanta.org/hospitals-near-me/gurugram-hospital/speciality/gi-surgery/disease/understanding-esophageal-varices-causes-symptoms-treatment

  Esophageal varices are caused by the following reasons: […] Esophageal varices are brought on by increased pressure in the portal veins, which are the veins that convey blood from the intestines to the liver. Cirrhosis, in particular, is frequently the cause of this elevated pressure in the liver. […] In the disease known as cirrhosis, good liver tissue is replaced by scar tissue, which can obstruct the flow of blood through the liver and clog the portal vein. Blood can back into smaller vessels, including those in the esophagus, when the pressure in the portal vein rises, leading to their enlargement and swelling. […] Blood clots in the portal vein, liver tumours, and specific genetic abnormalities are additional factors that can raise the pressure in the portal vein and result in esophageal varices. Cirrhosis and esophageal varices risk factors include excessive alcohol use and persistent viral hepatitis.

• #14

  https://www.aurorahealthcare.org/services/gastroenterology-colorectal-surgery/esophageal-motility-disorders/esophageal-varices

  Esophageal varices can be a serious, sometimes life-threatening, result of advanced liver disease. […] Esophageal varices are enlarged veins in the esophagus. […] These swollen vessels develop because of blockages in the blood routes going to the liver. […] Blood clots, liver disease and certain infections can lead to esophageal varices. […] The top culprit of esophageal varices is liver scarring from diseases such as hepatitis C, which causes the liver to work harder and possibly shut down. […] Another usual cause is a rise in blood pressure in veins that run from the pancreas to the liver. This is known as portal hypertension and is often related to liver problems. […] A block in the main blood route can force blood into other paths, such as those in the esophagus. […] Some infections, certain cardiovascular conditions and growths might also play a role in the development of esophageal varices.

• #15 English | World Gastroenterology Organisation

  https://www.worldgastroenterology.org/guidelines/esophageal-varices/esophageal-varices-english

  Esophageal varices are Porto-systemic collaterals i.e., vascular channels that link the portal venous and the systemic venous circulation. They form as a consequence of portal hypertension (a progressive complication of cirrhosis), preferentially in the sub mucosa of the lower esophagus. […] Approximately 50% of patients with cirrhosis develop gastroesophageal varices. Gastric varices are present in 533% of patients with portal hypertension. […] The presence of gastroesophageal varices correlates with the severity of liver disease. […] An international normalized ratio (INR) score 1.5, a portal vein diameter of 13 mm, and thrombocytopenia have been found to be predictive of the likelihood of varices being present in cirrhotics. […] Schistosomiasis is the most common cause of varices in the setting of developing countries in Egypt or the Sudan, for example. In absolute numbers, it may be a more common cause than liver cirrhosis. […] There are many conditions that can lead to esophageal varices.

• #16 Esophageal varix | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/oesophageal-varix?lang=us

  Esophageal varices describe dilated submucosal veins of the esophagus, and are an important portosystemic collateral pathway. They are considered distinct from gastric varices, which are less common. […] Esophageal varices are present in ~50% of patients with portal hypertension. They occur in greater frequency in patients with more severe cirrhosis, for example esophageal varices may be present in ~40% of patients with Child-Pugh A cirrhosis, but in ~85% of patients with Child-Pugh C cirrhosis. […] Additionally, patients will often have stigmata of portal hypertension and cirrhosis the most common etiological basis for esophageal varices. […] typically caused by portal hypertension, as a collateral pathway between the portal vein and the superior vena cava (via the azygos vein). […] the most common cause of this phenomenon is cirrhosis secondary to alcohol excess, however less common etiologies include primary biliary cholangitis, primary sclerosing cholangitis, portal vein thrombosis, Budd-Chiari syndrome, and schistosomiasis. […] typically caused by superior vena cava obstruction, as part of superior vena cava syndrome, as a collateral pathway between the superior vena cava into the portal circulation and/or the inferior vena cava.

• #17 Patient education: Esophageal varices (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/esophageal-varices-beyond-the-basics/print

  Cirrhosis is a disease in which the liver becomes severely scarred, usually as a result of many years of continuous injury. The most common causes of cirrhosis include steatotic (fatty) liver (due mostly to obesity), alcohol use disorder, and chronic hepatitis B or C virus infection. Some people have more than one cause of injury to the liver. […] Varices develop when blood flow through the liver is obstructed (blocked) by scarring, increasing the pressure inside the portal vein, which carries blood from the intestines to the liver; this condition is called portal hypertension. […] Weight loss/control of associated conditions — Many people with cirrhosis have steatotic liver disease due to obesity. Obesity may be the sole cause of liver damage, or may be a contributing factor. Losing weight can remove fat from the liver and may reduce further injury.

• #18 Esophageal Varices: Symptoms, Causes, Treatments

  https://resources.healthgrades.com/right-care/vascular-conditions/esophageal-varices

  Esophageal varices are veins in the esophagus that have widened and enlarged. This dilation is due to portal hypertension, which is high blood pressure in the portal vein. […] Liver cirrhosis is the most common cause of portal hypertension and the development of esophageal varices. Cirrhosis is permanent scarring of the liver, which blocks blood flow through the liver. In the United States, the most common causes of liver cirrhosis include: alcohol use disorder, chronic hepatitis, nonalcoholic fatty liver disease. […] Other possible causes of esophageal varices include: alpha-1 antitrypsin deficiency, which causes liver disease; Budd-Chiari syndrome, which is narrowing of the hepatic vein that carries blood from the liver to the heart; constrictive pericarditis, which causes scarring and thickening of the sac around the heart as well as a backup of blood in the veins; right sided heart failure, which causes a backup of blood in the veins; enlarged spleen; obstruction of the portal vein, such as a blood clot; schistosomiasis, which is a parasitic infection; Wilson disease, which causes excess copper and damage in organs including the liver.

• #19 Esophageal Varices Overview | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/gastroenterology/esophageal-varices

  Esophageal varices are enlarged blood vessels in your esophagus (the muscular tube connecting the mouth to the stomach). They are usually found in patients with chronic liver disease. […] The greatest risk factor for esophageal varices is cirrhosis (scarring) of the liver from hepatitis, fatty liver disease and alcoholic liver disease; blood clot; and a parasitic infection called schistosomiasis. […] With esophageal varices, blood vessels in the esophagus become abnormally enlarged. They may then rupture (burst) and bleed.

• #20 Esophageal Varices | Digestive Disease Center of CNY

  https://ddcofcny.com/education/diseases/esophageal-varices/

  Esophageal varices occur when normal blood flow to your liver is slowed. […] Liver disease may create scar tissue in the liver which slows the flow of blood. […] The most common causes of cirrhosis include longstanding alcohol abuse, chronic hepatitis and nonalcoholic steatohepatitis (fat builds up in the liver and the liver becomes inflamed).

• #21 Esophageal Varices – The Gastro Clinic

  https://www.gastroclinic.com/conditions/esophageal-varices/

  Esophageal varices are usually a consequence of portal hypertension, commonly found in cirrhosis of the liver patients. […] Increased pressure in the veins that deliver blood to the liver leads to the formation of esophageal varices. This increased pressure causes blood to back up into other smaller vessels. […] NAFLD non-alcohol fatty liver disease, Chronic Hepatitis C or B, Alcohol abuse, Any chronic liver disease that leads to cirrhosis.

• #22 Esophageal Varices

  https://www.digestivespecialists.com/condition/esophageal-varices

  The most common causes of esophageal varices include: […] Scarring of the liver or cirrhosis. Many liver diseases can cause cirrhosis such as hepatitis, alcoholic liver disease, fatty liver disease and bile duct disorders. About 40 percent of people who have cirrhosis develop esophageal varices. […] Thrombosis (blood clots). A clot in the portal vein or feeder vein into the portal vein can cause varices. […] Parasite infection. Schistosomiasis is a parasitic infection that can damage the lungs, intestines, bladder and liver. […] Budd-Chiari syndrome. This is a rare condition that can cause blood clots in the hepatic system.

• #23 Esophageal Varices: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15429-esophageal-varices

  Blood clots. Thrombosis in your portal venous system can obstruct blood flow into your liver, through your liver or out of your liver. Many things can cause this, including inherited diseases. A blood clot in one of the veins coming out of your liver is known as Budd-Chiari syndrome. […] Enlarged spleen. This may be a symptom of liver disease or an acute infection. A swollen spleen may create new blood vessels that feed into the portal venous system. […] Heart conditions. Right-sided heart failure or constrictive pericarditis may create pressure and backflow in your portal venous system.

• #24 Esophageal Varices: Causes, Risk factors and Prevention Tips – VIMS

  https://vims.ac.in/vims-hospital/esophageal-varices-causes-risk-factors-and-prevention-tips/

  The primary cause for esophageal varices is the malfunctioning of the liver. People who have liver cirrhosis are under constant threat to develop this condition. The liver cleanses toxins from the body. When the blood flow to this crucial organ is restricted, it flows into the nearby vessels, increasing the supply. Because of this esophagus is one of the several organs that receive excess blood. The blood vessels in the esophagus are small and incapable of carrying surplus blood, leading to swelling up and resulting in varices. […] Other contributing factors leading to varices are: Thrombosis or blood clot in the portal vein. Blockage of veins in the liver also known as Budd-Chiari syndrome. Schistosomiasis, also known as bilharzia a disease caused by parasitic worms.

• #25 What are esophageal varices? Types, treatments, and more

  https://www.medicalnewstoday.com/articles/esophageal-varices

  Varices are large or swollen blood vessels, which can be located around the esophagus. The most common cause of esophageal varices is scarring of the liver. […] The most common cause is portal hypertension, which most commonly results from liver cirrhosis. […] Cirrhosis is severe scarring of the liver caused by a disease, such as hepatitis C. It is the most common underlying cause of esophageal varices. […] Portal hypertension is a complication of cirrhosis. It happens when scar tissue blocks the flow of blood around the liver. This leads to high blood pressure in the portal vein, which carries blood from other organs to the liver. […] Rarer causes of esophageal varices can include Budd-Chiari syndrome and schistosomiasis. […] Budd-Chiari syndrome causes veins in the liver to become partially blocked. Schistosomiasis is a disease caused by parasitic worms. These can get into the blood vessels, which may cause them to become varices. […] Cirrhosis and portal hypertension are the most common causes of esophageal varices. These are both possible complications of liver disease.

• #26 Portal Hypertension: Common Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/4912-portal-hypertension

  In Western nations, portal hypertension is most commonly caused by cirrhosis of the liver. […] In other areas of the world, a parasite infection called schistosomiasis is the more common cause. […] Causes include: Cirrhosis of the liver. This is generally the end stage of chronic liver disease, most commonly viral hepatitis C, alcohol-induced hepatitis and nonalcoholic fatty liver disease. […] Granulomas of the liver. Granulomas are collections of inflammatory cells that accompany various infections and inflammatory diseases (such as schistosomiasis). […] Blood clots. Thrombosis in the portal venous system can obstruct blood flow into the liver, through the liver or out of the liver.

• #27 Esophageal Varices | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116220/all/Esophageal_Varices?q=B+Hepatitis

  Dilated submucosal esophageal veins connecting the portal and systemic circulations. […] Most commonly results from portal hypertension (usually a result of cirrhosis). […] Portal hypertension causes the formation of portacaval anastomoses to decompress the portal circulation. This leads to a congested submucosal venous plexus with tortuous dilated veins, particularly in the distal esophagus. Variceal rupture results in hemorrhage. […] Causes of portal hypertension: Prehepatic: Extrahepatic portal vein obstruction, Massive splenomegaly with increased splenic vein blood flow. […] Posthepatic: Severe right-sided heart failure, constrictive pericarditis, and hepatic vein obstruction (Budd-Chiari syndrome). […] Intrahepatic: Cirrhosis (accounts for most cases of portal hypertension). […] Less frequent causes are schistosomiasis, massive fatty change, diseases affecting portal microcirculation as nodular regenerative hyperplasia, and diffuse fibrosing granulomatous disease as sarcoidosis.

• #28 Downhill esophageal varices: a systematic review of the case reports

  https://www.explorationpub.com/Journals/em/Article/100196

  The etiologies, presentation, and management of downhill varices in the era of modern medicine are relatively under-explored and mostly limited to case reports or case series. […] Dialysis catheter-associated superior vena cava obstruction resulted in an increased risk of downhill varices. Other causes include thyroid malignancies, pulmonary hypertension, and Behets disease. […] Several causes of downhill varices have been reported in literature, most common of which is SVC syndrome and associated vascular occlusion. Other causes include mediastinal fibrosis, Behets syndrome, catheter manipulation, retrosternal goiter and other thyroid masses, thymomas, bronchial carcinomas, metastases, pulmonary hypertension, and lymphomas. […] In the present study, hematemesis and melena were the most common presenting symptoms. Other presenting symptoms included symptomatic anemia, dysphagia, abdominal pain, hematochezia, and symptoms of SVC obstruction. […] The majority of cases underwent management based on the etiology. […] Dialysis catheter-associated SVC obstruction remains the most known cause in ESRD patients.

• #29

  https://journals.lww.com/ajg/fulltext/2022/10002/s2438_a_rare_cause_of_esophageal_varices.2439.aspx

  Esophageal varices (EV) are classified as downhill or uphill varices. Uphill varices are common and found in the distal esophagus that develop secondary to portal hypertension. Downhill esophageal varices (DEV) are rare and found in the proximal and mid esophagus and most commonly develop from obstructed venous blood flow in the superior vena cava (SVC). […] DEV are formed when there is an obstruction in the SVC causing retrograde blood flow into the right atrium through collateral channels. The proximal and mid esophageal veins drain into the collaterals and the increased pressure result in DEV. The most common etiology is thrombosis of the SVC, but DEV can also be caused by severe pulmonary hypertension, thyroid tumors, and complications with HD catheters. In our case, the patients prior chronic HD catheter likely caused narrowing of the SVC lumen, along with long-standing pulmonary hypertension.

• #30 Learning Radiology – Esophageal, Varices, esophagus, varix

  https://learningradiology.com/notes/ginotes/esophagusvarixpage.htm

  Esophageal Varices […] Dilated submucosal veins due to increased collateral blood flow from portal venous system to azygos system […] Most common cause is portal hypertension secondary to cirrhosis […] Causes […] Intrahepatic obstruction from cirrhosis […] Splenic vein thrombosis (usually gastric varices only) […] Obstruction of hepatic veins […] Portal vein thrombosis […] IVC obstruction below hepatic veins […] Marked splenomegaly / splenic hemangiomatosis (rare) […] Less common than uphill varices […] Causes […] Obstruction of superior vena cava distal to entry of azygos vein due to […] Lung cancer (most common) […] Lymphoma […] Retrosternal goiter […] Thymoma […] Mediastinal fibrosis.

• #31

  https://journals.lww.com/ajg/fulltext/2010/10001/a_case_of_downhill_esophageal_varices__a_rare.1046.aspx

  Downhill varices are varices of the upper esophagus. This is a rare complication of superior vena cava (SVC) obstruction and may be caused by tumor, thrombus, or complicated central venous catheter (CVC). […] The etiology of downhill varices includes upper mediastinal tumors, most commonly lung, thyroid, and metastases. Other causes are mediastinal fibrosis, venulitis, surgical ligation of the SVC, and complicated CVC placement. […] Findings of downhill esophageal varices on EGD should prompt further investigation for the SVC obstruction. Conversely, in patients with known SVC obstruction, downhill esophageal varices should be in the differential diagnosis of the upper GI bleeding.

• #32 Upper esophageal varices (Downhill varices): Case presentation and literature review

  http://www.scielo.org.co/scielo.php?pid=S0120-99572020000100043&script=sci_arttext&tlng=en

  We describe 21 cases with incidental endoscopic findings of upper esophageal varices (downhill varices) and relevant data from patients clinical histories and endoscopic findings. […] The most frequent comorbidity was chronic obstructive pulmonary disease, followed by pneumoconiosis, obesity and apnea-hypopnea syndrome. All comorbidities had associated pulmonary hypertension. The last three causes have not been previously described in the literature on upper esophageal varices. […] Upper esophageal varices are rarely found endoscopically, but when have been, they have been found incidentally or as part of an examination of upper gastrointestinal bleeding. […] The most frequent cause in the initial descriptions were obstructions due to mediastinal tumors or fibrosis of the mediastinum.

• #33 Upper esophageal varices (Downhill varices): Case presentation and literature review

  http://www.scielo.org.co/scielo.php?pid=S0120-99572020000100043&script=sci_arttext&tlng=en

  Their etiologies vary and are different from the classic ones mentioned above. […] The name downhill varices was coined by Felson in 1964 for the rare finding of upper esophageal varices. […] The first descriptions found that this pathology was related to extrinsic compression of the SVC and were generally associated with mediastinal tumors which frequently have pulmonary origins or are due to lymphomas. […] Nevertheless, subsequent publications about this condition described various pathologies including giant benign lymphomas, mediastinal thymomas, and intrathoracic goiters. […] In our series, most of the patients were older adults (15/21: 71%), and men and women in this group were equally affected. Fifty-seven percent had lung diseases, and of these COPD was the most important. […] Pneumoconiosis (mainly silicosis), pneumonitis due to organic solvents and DILD had not previously been reported as causes proximal varices, but they accounted for 19% of the cases in this series.

• #34 To Band or Not To Band? Esophageal Varices in the Pediatric Population | AASLD

  https://www.aasld.org/liver-fellow-network/core-series/clinical-pearls/band-or-not-band-esophageal-varices-pediatric

  Extrahepatic portal vein obstruction and biliary atresia are the most common causes of portal hypertension in the pediatric population. […] Procoagulant and proinflammatory states are risk factors for EHPVO. Specifically in children, omphalitis, umbilical vein cannulation, abdominal infections/sepsis, surgeries or trauma can increase the risk of EHPVO. […] The overall incidence and mortality of variceal bleeding in children is lower than in adults. […] Primary prophylaxis of esophageal varices with band ligation is not a standard practice. […] Band ligation is the preferred method of endoscopic management of esophageal varices that have bled or have high likelihood of bleeding. Sclerotherapy is used for smaller children (typically 10 kg). […] Surgical shunts are typically recommended for refractory symptoms of portal hypertension. Meso Rex bypass shunts are typically preferred for pediatric patients with EHPVO.

• #35 Bleeding Esophageal Varices: Symptoms and Causes

  https://www.healthline.com/health/bleeding-esophageal-varices

  In some cases, the cause of portal hypertension is unknown. This is referred to as idiopathic portal hypertension. […] Factors that can increase the risk of bleeding include: Higher portal blood pressure. The higher the portal blood pressure, the greater the risk of bleeding. […] The size of the varices. The risk of bleeding increases with size. Larger varices have a higher risk of bleeding. […] Advanced liver disease. People with severe liver disease, including advanced cirrhosis or liver failure, are at higher risk of bleeding esophageal varices. […] Continued consumption of alcohol. If the varices are due to alcohol consumption, continuing to drink increases the risk of bleeding.

• #36 Oesophageal varices – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000253

  Oesophageal varices are a direct consequence of portal hypertension as a progressive complication of cirrhosis. […] In the US and Europe the major cause of cirrhosis is alcoholic liver disease. Worldwide, hepatitis B virus infection and hepatitis C virus infection are the major causes of cirrhosis. […] Once cirrhosis has developed, increasing hepatic vein pressure gradient and deteriorating liver function may result in the formation of oesophageal varices. […] Rupture of oesophageal varices can cause life-threatening bleeding. The most important predictor of variceal haemorrhage is the size of varices, with the highest risk of first haemorrhage occurring in patients with large varices (15% per year). […] Other important predictors of haemorrhage are decompensated cirrhosis (Child-Pugh B/C) and the endoscopic finding of red wale marks. […] Key diagnostic factors include presence of risk factors for variceal bleeding, cirrhosis, and severe liver disease. […] Risk factors include portal hypertension, large varices, red wale marks, decompensated cirrhosis, and ascites.

• #37 Portal Hypertension: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/182098-overview

  Studies have demonstrated the role of ET-1 and NO in the pathogenesis of portal hypertension and esophageal varices. […] The second factor that contributes to the pathogenesis of portal hypertension is an increase in blood flow in the portal veins. […] An elevated pressure difference between systemic and portal circulation (ie, HVPG) directly contributes to the development of varices. […] Gastroesophageal varices have two main inflows. […] The hypertensive portal vein is decompressed by diverting up to 90% of the portal flow through portosystemic collaterals back to the heart, resulting in enlargement of these vessels. […] Increased portal pressure contributes to increased varix size and decreased varix wall thickness, thus leading to increased variceal wall tension. […] The following are risk factors for variceal hemorrhage: Variceal size, the presence of endoscopic red color signs, Child B or C classification, active alcohol intake in patients with chronic, alcohol-related liver diseases, local changes in the distal esophagus, and bacterial infection.

• #38 Diagnosis and Management of Esophagogastric Varices

  https://www.mdpi.com/2075-4418/13/6/1031

  Esophageal varices (EV) are one of the most common causes of acute upper gastrointestinal bleeding (UGIB) with varying prevalence worldwide. […] Cirrhosis is the most common cause of EV in the Western world, with up to 85% of cirrhotic patients developing EV at some point in their lives, the incidence varying with disease severity. […] The prevalence of schistosomiasis has been linked to EV in certain parts of the developing world. […] Esophageal varices develop as a result of portal hypertension (PH), which is traditionally assessed indirectly by determining the hepatic venous pressure gradient (HVPG): PH is defined as an HVPG > 5 mmHg, while clinically significant portal hypertension (CSPH) is defined in presence of a gradient > 10 mmHg. […] The increased resistance is mainly due to a combination of structural changes (distortion of the liver microcirculation by fibrosis, nodules, angiogenesis, and vascular occlusion) and dynamic changes (increased release of vasoconstrictors as angiotensin-II, norepinephrine, thromboxane A2 and endothelins, and the reduced production of vasodilators as nitric oxide).

• #39 Esophageal Varices – Esophageal Health | UCLA Health

  https://www.uclahealth.org/medical-services/gastro/esophageal-health/diseases-we-treat/esophageal-varices

  Esophageal varices are abnormally dilated veins in the esophagus that are an important and common complication of liver disease. […] Esophageal varices occur as a complication of cirrhosis of any cause but can occasionally happen in liver disease without cirrhosis. […] Varices are the result of portal hypertension: as the liver decompensates and scars in cirrhosis, there is increased resistance of blood flow through the liver. This back-up of blood flow increases the pressure in certain blood vessels upstream of the liver, causing them to increase in size and be prone to bleeding. […] Identification of esophageal varices in patients with cirrhosis is important because the bleeding can be dramatic and even life threatening.

• #40 Not all varices are from cirrhosis – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/news/not-all-varices-are-from-cirrhosis/

  Cirrhosis is the most common cause of portal hypertension and varices in the Western world. However, varices can arise in patients with portal hypertension in the absence of cirrhosis or even in the absence of portal hypertension. […] Worldwide, the leading cause of non-cirrhotic portal hypertension is schistosomiasis (230 million infected), a parasitic disease caused by trematode flukes. In Western countries, the leading causes of non-cirrhotic portal hypertension are alcoholic hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, congenital hepatic fibrosis, extrahepatic portal vein thrombosis and Budd-Chiari syndrome. […] Downhill varices are usually caused by superior vena cava obstruction due to bronchogenic carcinoma, mediastinal tumor/fibrosis, caval ligation, thyroid masses or lymphoma. Downhill varices are collaterals that develop to bypass the superior vena cava obstruction. […] For patients with an identifiable cause of non-cirrhotic portal hypertension, such as primary biliary cirrhosis, disease-specific treatment should be initiated.

• #41 Bleeding esophageal varices – UF Health

  https://ufhealth.org/conditions-and-treatments/bleeding-esophageal-varices

  The esophagus (food pipe) is the tube that connects your throat to your stomach. Varices are enlarged veins that may be found in the esophagus in people with cirrhosis of the liver. These veins may rupture and bleed. […] Scarring (cirrhosis) of the liver is the most common cause of esophageal varices. This scarring cuts down on blood flowing through the liver. As a result, more blood flows through the veins of the esophagus. […] Any type of long-term (chronic) liver disease can cause esophageal varices. […] Bleeding esophageal varices are a serious complication of liver disease and have a poor outcome. […] Treating the causes of liver disease may prevent bleeding.

• #42 Esophageal varices – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/esophageal-varices/diagnosis-treatment/drc-20351544

  If someone is diagnosed with cirrhosis, a healthcare professional will then typically screen for esophageal varices. […] Treatments may include: […] A type of blood pressure drug called a beta blocker may help reduce blood pressure in the portal vein. This can decrease the likelihood of bleeding. […] If the esophageal varices appear to have a high risk of bleeding, or if the varices have bled before, a healthcare professional might recommend a procedure called endoscopic band ligation. […] Medicines such as octreotide (Sandostatin) and vasopressin (Vasostrict) slow the flow of blood to the portal vein. […] If medicine and endoscopy treatments don’t stop the bleeding, a care professional might recommend a procedure called transjugular intrahepatic portosystemic shunt (TIPS). […] There is a high risk that bleeding will recur in people who’ve had bleeding from esophageal varices. […] Researchers are exploring an experimental emergency therapy to stop bleeding from esophageal varices that involves spraying an adhesive powder. […] Another possible way to stop bleeding when all other measures fail is to use self-expanding metal stents (SEMS).

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