Esophogeal Varices
by Nicole Cutler, L.Ac.
Occurring in approximately one in every 10,000 people, bleeding esophogeal varices are swollen veins in the esophagus or the upper part of the stomach that begin to bleed. They can be a life-threatening complication of portal hypertension, where there is increased blood pressure in the primary blood vessel leading into the liver. Because veins are not designed to handle high internal pressure, the engorgement of veins causes them to be fragile and bleed easily. If a large volume of blood is lost, signs of shock will develop (pallor, a rapid and weak pulse, rapid and shallow respiration and lowered systemic blood pressure).
Common culprit
Alcoholic and viral cirrhosis are the leading causes of portal hypertension in Western countries. As liver disease progresses, the risk of developing cirrhosis follows. Cirrhosis is the permanent scarring and hardening of liver tissue, which subsequently prohibits hepatic circulation. This hampering of blood flow through the liver increases the hepatic pressure that causes portal hypertension and sets the stage for blood vessels to burst. A bleeding esophogeal varice is the most serious complication in patients with cirrhotic liver disease.
Symptoms
Symptoms of a bleeding esophogeal varice include:
· Vomiting
· Vomiting blood
· Black, tarry stools
· Bloody stools
· Decreased urine output
· Symptoms of chronic liver disease (such as cirrhosis)
· Excessive thirst
· Paleness
· Light-headedness
Diagnosis
Any cause of chronic liver disease can also lead to a bleeding esophogeal varice. This is especially suspected from any of the above listed symptoms, or if afflicted with cirrhosis or chronic alcohol abuse. The definitive diagnosis is established via a specialized type of endoscopy, esophagogastroduodenoscopy (EGD), a procedure involving the visual examination of the lining of the esophagus, stomach, and upper duodenum with a flexible fiberoptic endoscope, a lighted device capable of looking inside a body cavity.
Treatment
The objective during treatment of a bleeding esophogeal varice is twofold:
1. Stopping and/or preventing bleeding;
2. Restoring and/or maintaining normal blood circulation.
Since uncontrolled bleeding can have drastic and final consequences, those with severe bleeding must be treated with attentive medical care.
Some of the allopathic techniques to stop bleeding and restore normal circulation include:
· Endoscopic therapy – By using an endoscope to access esophogeal varices, a physician may inject the offending vein with a clotting agent or place a rubber band around it.
· Balloon tamponade – A tube is inserted through the nose into the stomach and inflated with air to produce pressure against the bleeding veins.
· Transjugular intrahepatic portosystemic shunt (TIPS) - A catheter is extended through a vein across the liver where it connects the portal system to the hepatic veins (veins that leave the liver and drain to the heart), decreasing the portal venous pressure.
· Medications - Octreotide and vasopressin are among the medications typically used to decrease portal blood flow and slow bleeding.
Prevention
Treatment of the underlying causes of liver disease also contributes to bleeding prevention. If the individual drinks alcohol, immediate cessation of drinking is crucial. Medications such as beta blockers to reduce blood pressure or endoscopic banding to stop leaking veins are commonly employed to prevent first time or recurrent bleeding esophogeal varices episodes.
Alternative treatments are aimed at preventing the development of progression of cirrhosis of the liver. By halting the hardening of liver tissue, this approach serves to maintain the best hepatic circulation possible, ultimately reducing the risk of bleeding esophogeal varices. However, once a patient has reached the bleeding stage, standard medical intervention is required. Some popular alternative treatments to prevent liver disease progression include:
· Herbal Supplements - The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, like medications, contain active substances capable of triggering side effects and interacting with other herbs, supplements or medications. Therefore, herbs should be taken with a physician’s consent. Milk thistle is one of the most reputed herbs for supporting the liver and preventing cirrhosis progression.
· Acupuncture – According to a 1997 Consensus Statement by the National Institutes of Health, acupuncture is an effective adjunct treatment for addiction, including alcoholism. For a person with alcohol-related cirrhosis, anything to help maintain abstinence is a sound preventative method. In addition, this centuries old therapy has been shown to increase hepatic circulation and decrease blood pressure.
· Dietary Counseling - Malnutrition is typically a problem for people with cirrhosis. Because the liver processes and is affected by everything we ingest, eating a healthy diet is an important part of treatment for cirrhosis. A dietician or nutritionist can guide a person to change their diet and consume foods that will benefit their particular body.
Being aware of this dangerous consequence of liver disease can prompt some to take preventative steps, alert those with cirrhosis what to look out for and serve as educative material for those currently addressing bleeding esophogeal varices.
References:
www.bmj.com, ABC of diseases of liver, pancreas, and biliary system, J E J Krige, I J Beckingham, BMJ Volume 322, February 10, 2001.
www.consensus.nih.gov, Acupuncture, National Institutes of Health Consensus Development Program, 1997.
www.healthatoz.com, Bleeding Varices, Medical Network, Inc., 2006.
www.nlm.nih.gov, Bleeding Esophogeal Varices, A.D.A.M. Inc., 2005.
www.umm.edu, Cirrhosis, University of Maryland Medical Center, 2004.
