American Medical Association Family Medical Guide - American Medical Association [488]
Diagnosis and Treatment
To diagnose esophageal varices, a doctor will perform a procedure called endoscopy (see page 766) to examine the veins at the lower end of the esophagus.
Esophageal varices
Esophageal varices are bulging veins in the walls of the lower part of the esophagus that occur as a result of increased blood pressure in the portal vein, which carries blood from the stomach and intestines to the liver. The condition, which results from liver damage, can be life-threatening if the veins burst and bleed.
If you have esophageal varices, your doctor will prescribe a blood pressure medication such as a beta blocker to lower the pressure in the portal vein. If the varices rupture, you will immediately be admitted to the intensive care unit of the hospital and given a synthetic hormone called octreotide intravenously (through a vein). The hormone decreases pressure in the portal vein and helps reduce the bleeding.
To evaluate the problem, a doctor will pass an endoscope (viewing tube) through your esophagus to the varices. To stop the bleeding, he or she will then either inject a chemical agent through the endoscope into the ruptured vein to cause it to scar or place a rubber band around the vein to seal it off.
WARNING!
Esophageal Varices
Bleeding from esophageal varices can be life-threatening. Call 911 or your local emergency number or go to the nearest hospital emergency department immediately if you have the following symptoms:
• Vomiting or spitting up bright red or dark blood
• Unusually pale skin
• Dark stool
Wear a medical identification bracelet with the words “esophageal varices” on it (and that states your blood type) so that emergency personnel can treat you promptly and effectively in an emergency.
If the bleeding cannot be stopped with these measures, the doctor may try inserting an endoscope into the esophagus and passing a deflated balloon through the endoscope to the site of the varices. The balloon is then inflated, putting pressure on the veins in the esophagus and stopping the bleeding. Often, a procedure called transjugular intrahepatic portosystemic shunt (TIPSS) is performed to reroute the portal vein to connect directly to the hepatic vein (which drains blood from the liver), relieving some of the pressure inside the esophagus.
Cancer of the Esophagus
Cancer of the esophagus is rare. But when cancer develops in the lining of the esophagus, the cancer cells multiply rapidly and are likely to spread to other parts of the body. The tumor eventually blocks the passageway to the stomach. Esophageal cancer can be divided into two main types—squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma develops in the cells that line the esophagus. Because the entire esophagus is lined with squamous cells, squamous cell carcinoma can occur anywhere in the esophagus. Squamous cell carcinoma used to be responsible for 90 percent of all esophageal cancers but now makes up only 50 percent.
Adenocarcinomas usually develop in glandular tissue in the lining of the lower part of the esophagus. Adenocarcinoma can result from tissue changes in the esophagus caused by chronic inflammation from gastroesophageal reflux disease (GERD; see page 750).
Cancer of the esophagus has been linked to long-term exposure to irritants such as tobacco smoke and alcohol. A person’s risk of cancer of the esophagus increases even more when he or she both smokes and drinks. The cancer is more common in men than in women and usually develops after age 60. Esophageal cancer is almost always fatal. However, it can be successfully treated if it is diagnosed at an early stage.
Symptoms
The main symptom of esophageal cancer is difficulty swallowing, or pain that becomes progressively worse when swallowing.