Oesophageal Varices
Oesophageal varices are portosystemic collaterals, usually caused by cirrhosis, that can rupture and cause life-threatening upper gastrointestinal haemorrhage; suspected variceal bleeding needs simultaneous resuscitation, vasoactive treatment, antibiotics and urgent endoscopic control.
Definition
Oesophageal varices are dilated submucosal portosystemic veins in the oesophagus, usually caused by portal hypertension from cirrhosis. Variceal haemorrhage is bleeding from these veins and is a time-critical cause of upper gastrointestinal bleeding.
First principles
Portal hypertension creates collateral veins
In cirrhosis, increased resistance to portal flow and increased splanchnic inflow raise portal pressure. Blood is diverted through portosystemic connections at the gastro-oesophageal junction, where the submucosal veins enlarge into varices. Cirrhosis is the commonest cause, but extrahepatic portal or splenic venous obstruction can also produce them.
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