WARNING SIGNS OF OESOPHAGEAL VARICES YOU SHOULD NOT IGNORE

Bleeding Oesophageal Varices: What Are They?

Bleeding oesophageal varices occur within the lower third of the oesophagus, where blood vessels become extremely dilated beneath the mucosal layer. These enlarged veins form because of blocked blood flow through the portal vein, forcing blood to seek alternative pathways through smaller vessels in the oesophagus.

The condition primarily develops through a chain reaction in the body's circulatory system. Furthermore, as blood pressure increases within the portal vein, these thin-walled veins balloon outward under the strain. Subsequently, the weakened vessel walls become prone to rupture, leading to severe internal bleeding.

The severity of this condition is evident in its progression. Many individuals with cirrhosis already experience complications like portal hypertension and oesophageal varices at the time of diagnosis, and the likelihood of developing these issues increases significantly over time. 

Doctors typically diagnose oesophageal varices through an esophagogastroduodenoscopy (EGD), which involves using a camera on a flexible tube to examine the oesophagus. 

The medical community recognises several treatment approaches for bleeding varices. The main therapeutic methods include:

• Variceal ligation (banding)

• Sclerotherapy

• Blood volume resuscitation

• Antibiotic treatment

In cases where standard treatments prove ineffective, doctors might employ advanced interventions such as balloon tamponade or fully-covered oesophageal self-expandable metallic stents. 

Blood loss management requires careful consideration. Medical teams aim to maintain hemodynamic stability with haemoglobin levels above 8 g/dl. Moreover, they must balance the need to restore blood volume against the risk of increasing portal pressure, which could trigger additional bleeding episodes.

Oesophageal Varices Symptoms

Most people with oesophageal varices notice no symptoms until bleeding begins. However, recognising these warning signs can make a crucial difference in seeking timely medical care.

Vomiting blood or coffee ground-like material: 

A slow blood leak often appears as dried, coagulated blood resembling coffee grounds in vomit. Still, a ruptured vein produces fresh, bright red blood, which might occur in large amounts.

Passing dark-coloured or black stools:

Blood passing through the digestive system typically turns black, giving stools a tar-like appearance. However, fresh red blood might appear in the stool during rapid bleeding episodes.

Lightheadedness:

Blood loss from bleeding varices commonly causes dizziness and a feeling of unsteadiness. This symptom often accompanies other signs of blood loss and requires immediate medical attention.

Paleness:

The face and skin might appear unusually pale. This pallor serves as a visible indicator of significant blood loss.

Weakness:

Substantial blood loss leads to feelings of tiredness and weakness. These symptoms often worsen as bleeding continues.

Sweating:

Cold, clammy skin accompanied by sweating indicates severe blood loss. This symptom frequently occurs alongside other signs of shock.

Rapid heartbeat:

The heart beats faster to compensate for blood loss. This increased heart rate represents the body's attempt to maintain adequate blood flow.

Low blood pressure:

Blood pressure drops significantly as blood volume decreases. 

Loss of consciousness in severe cases:

In cases of severe bleeding, a person might lose consciousness. This serious complication demands immediate emergency care.

These symptoms often occur together rather than in isolation. The presence of multiple symptoms typically indicates a more severe bleeding episode. Notably, bleeding from oesophagal varices remains painless, though this absence of pain should not delay seeking medical help.

Bleeding Oesophageal varices Causes

The underlying causes of oesophageal varices stem from specific medical conditions that affect blood flow through the liver:

Cirrhosis of the liver:

Scarring of the liver tissue marks the primary trigger for oesophageal varices. This scarring process, known as cirrhosis, typically develops over many years of continuous liver injury. 

The gradual transformation of healthy liver tissue into scar tissue blocks normal blood flow, setting off a chain of events that leads to variceal formation.

High blood pressure in the portal vein:

Portal hypertension occurs as a direct result of blocked blood flow through the scarred liver. The normal portal vein pressure ranges between 5-10 mmHg, although this can rise dramatically to 15-20 mmHg in cases of portal obstruction. Since the portal venous system lacks valves, any resistance between the splanchnic vessels and the right side of the heart causes retrograde flow and elevated pressure.

The body attempts to compensate for this increased pressure by forming new blood vessel connections, called portocaval anastomoses

• , often through veins in the oesophagus

• . As a result, these oesophagal veins become swollen and 

• fragile, forming oesophagal varices.

What Increases Your Risk of Bleeding Varices?

Several factors heighten the risk of bleeding from oesophageal varices. Doctors carefully monitor these risk indicators to prevent life-threatening complications.

• Portal vein pressure is a primary indicator of bleeding risk. As pressure within this vital blood vessel rises, the likelihood of variceal rupture increases substantially.

• The size of varices plays a crucial role in determining bleeding risk. Varices larger than 5 millimetres face a considerably higher chance of rupture.

• Red colour markings on varices serve as another vital warning sign. Doctors identify these through endoscopic examination.

• The severity of underlying liver disease markedly influences bleeding risk. Advanced cirrhosis typically correlates with increased portal pressure and larger varices, both contributing to higher rupture probability. 

• Previous bleeding episodes significantly raise the chances of recurrence. Once a patient experiences an initial bleeding episode, there exists a 70% likelihood of rebleeding.

• Certain lifestyle factors also impact bleeding risk. Continuous alcohol consumption, particularly in cases where alcohol caused the initial liver disease, dramatically increases the danger of variceal rupture. Furthermore, specific activities might trigger bleeding, including:

• Severe coughing

• Excessive vomiting

• Constipation

• Substantial alcohol intake

Nonsteroidal anti-inflammatory drugs merit special consideration. While these medications do not directly cause variceal bleeding, they might trigger upper gastrointestinal bleeding in individuals with portal hypertension, even when taking protective antiulcer drugs.

How Severe Can Bleeding Be? Potential Complications

Bleeding from oesophageal varices ranks among the most dangerous complications of liver disease. The initial bleeding episode carries a mortality rate of 20%, whilst the risk escalates to 30% during subsequent episodes.

The following are bleeding oesophageal varices complications:

• Life-threatening Haemorrhage: Severe and sudden bleeding from oesophageal varices may lead to massive blood loss. Without immediate medical intervention, it can become fatal.

• Recurrent Bleeding Episodes: Even after initial treatment, oesophagal varices have a 70% chance of rebleeding.

• Infections and Sepsis: Severe blood loss weakens the immune system, increasing the possibility of bacterial infections and sepsis.

Hepatic Encephalopathy: Blood loss and poor liver function may lead to toxins accumulating in the brain, causing confusion, disorientation, or even coma.

When to Seek Emergency Medical Help

Quick action saves lives when oesophageal varices begin to bleed. Doctors classify this condition as a life-threatening emergency that demands immediate attention.

Anyone experiencing black or bloody stools must immediately contact a doctor. Similarly, vomiting blood, regardless of the amount, requires urgent medical assistance.

Certain symptoms signal severe blood loss and hypovolemic shock, warranting immediate emergency care. These critical signs include:

• Fast heart rate combined with rapid breathing

• Cold, clammy skin alongside profuse sweating

• Mental changes, primarily anxiety and confusion

• Sudden loss of consciousness

Portal hypertension often precedes bleeding episodes. Patients with known liver conditions should watch for additional warning signs, such as:

• Yellowing of skin and eyes

• Spider-like blood vessels cluster beneath the skin

• Reddening of palm skin

• Hand deformities

• Fluid build-up in the abdomen

• Enlarged spleen

Conclusion

Oesophageal varices demand serious attention due to their life-threatening nature and high mortality rates. Though these enlarged veins often remain silent until bleeding begins, understanding the warning signs can make a crucial difference between life and death.

People with liver disease should stay alert for warning signs such as black stools, vomiting blood, or dizziness. Since bleeding can start without pain, patients must not wait for discomfort before seeking emergency care. Regular medical check-ups and proper management of underlying liver conditions remain the best defence against this dangerous condition.

The presence of varices requires ongoing monitoring because bleeding frequently recurs despite successful treatment. Therefore, patients should work closely with their doctors to develop an effective management plan that includes lifestyle changes and regular screening.

FAQs

What are oesophageal varices?

Oesophageal varices are enlarged veins in the lower oesophagus, usually caused by liver disease and portal hypertension.

What are bleeding oesophageal varices causes?

Increased pressure in the portal vein due to liver disease weakens vein walls, making them prone to rupture and bleeding.

What are bleeding oesophageal varices treatment options?

Treatments include endoscopic banding, sclerotherapy, medications (beta-blockers), and, in severe cases, a TIPS procedure or surgery.