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Esophageal Varices

Maximos Attia, FAAFP, MD and Marcelle Meseeha, FACP, MD Reviewed 04/2024
 


BASICS

DESCRIPTION

  • Dilated submucosal esophageal veins connecting the portal and systemic circulations

  • Most commonly results from portal hypertension (usually a result of cirrhosis)

  • Variceal rupture: mos...

DIAGNOSIS

  • First indication of varices is often GI bleeding: hematemesis, hematochezia, and/or melena.

  • Occult bleeding (anemia): uncommon

HISTORY

  • Underlying history of cirrhosis/liver disease. Variceal bl...

TREATMENT

GENERAL MEASURES

  • Treat underlying cirrhotic comorbidities.

  • Variceal bleeding is often complicated by hepatic encephalopathy and infection.

  • Active bleeding (1)

    • IV access, hemodynamic resuscitati...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Endoscopic variceal ligation, every 1 to 4 weeks, until varices eradicated

  • Endoscopic screening in patients with known cirrhosis every 2 to 3 yea...

REFERENCES

1
Jakab SS, Garcia-Tsao G. Evaluation and management of esophageal and gastric varices in patients with cirrhosis. Clin Liver Dis. 2020;24(3):335–335. 
2
Simonetto DA, Liu M, Kamath PS. Portal...

ADDITIONAL READING

Mauro E, Gadano A. What's new in portal hypertension? Liver Int. 2020;40(Suppl 1):122–127. doi: 10.1111/liv.14366.  

CODES

ICD10

  • I85.0 Esophageal varices

  • I85 Esophageal varices

  • I85.1 Secondary esophageal varices

  • I85.01 Esophageal varices with bleeding

  • I85.00 Esophageal varices without bleeding

  • I85.11 Secondary esophageal ...

CLINICAL PEARLS

  • Thrombocytopenia is the most sensitive marker of increased portal pressure and large esophageal varices.

  • Roughly half of all patients with cirrhosis will have esophageal varices. One in...

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