From the Guidelines
Esophageal varices often present with no symptoms until they rupture and bleed, and the main signs and symptoms include hematemesis, melena, hematochezia, and symptoms of blood loss such as lightheadedness, dizziness, fatigue, and syncope. The diagnosis of esophageal varices is typically made by endoscopic screening, and patients with known cirrhosis should undergo regular endoscopic screening for varices 1. The frequency of surveillance endoscopies in patients with no or small varices depends on their natural history, with patients with compensated cirrhosis who have no varices on screening endoscopy requiring EGD to be repeated in 2-3 years, and those who have small varices requiring EGD to be repeated in 1-2 years 1. In patients with decompensated cirrhosis, EGD should be repeated at yearly intervals 1. Some of the key signs and symptoms of esophageal varices include:
- Hematemesis (vomiting of blood)
- Melena (black, tarry stools)
- Hematochezia (bloody stools)
- Symptoms of blood loss such as lightheadedness, dizziness, fatigue, and syncope
- Abdominal pain
- Chest pain
- Dysphagia
- Signs of cirrhosis such as jaundice, ascites, spider angiomas, palmar erythema, and encephalopathy It is essential to note that early detection is crucial as the mortality rate from variceal bleeding is high, and patients with large varices may benefit from prophylactic treatment with non-selective beta-blockers like propranolol (20-40mg twice daily) or nadolol (20-40mg daily) to reduce the risk of first bleeding 1. The most recent and highest quality study on this topic is from 2018, which emphasizes the importance of early detection and treatment of esophageal varices in patients with cirrhosis 1. Overall, the management of esophageal varices requires a comprehensive approach that includes regular endoscopic screening, prophylactic treatment with non-selective beta-blockers, and prompt treatment of variceal bleeding.
From the Research
Signs and Symptoms of Esophageal Varices
The signs and symptoms of esophageal varices are not explicitly stated in the provided studies. However, the studies discuss the complications and treatment of esophageal varices, which can be used to infer the potential signs and symptoms.
Complications of Esophageal Varices
- Hemorrhage from esophageal varices is a life-threatening event in patients with liver cirrhosis 2
- Acute variceal bleeding is a complication of portal hypertension, usually due to cirrhosis, with high morbidity and mortality 3
- Esophageal varices can cause life-threatening complications and are most often a sequela of liver disease 4
Treatment and Prevention of Esophageal Varices
- Beta-blockers are a well-established cornerstone of the treatment of portal hypertension and primary and secondary prophylaxis for prevention of esophageal variceal bleeding 5
- Endoscopic variceal banding is the recommended endoscopic therapy for acute variceal bleeding 3
- Sclerotherapy, variceal band ligation, beta-blockers, transjugular intrahepatic portosystemic shunt (TIPS), and surgical portocaval shunts are available treatments for secondary prevention of variceal bleeding 6