Esophageal varices – colloquially called varicose veins of the esophagus – (synonyms: Bleeding venous varicosities of the esophagus; Bleeding varicosal ulcer of the esophagus; Downhill varices; Hemorrhage in esophageal varices; Esophageal varices without bleeding; Esophageal variceal hemorrhage; Esophageal varices; Esophageal varices; Varicose ulcer of the esophagus; Varicose bleeding ulcer of the esophagus; Varicose esophageal ulcer; Venous varicosis of the esophagus; ICD-10-GM I85. -: Esophageal varices) are varices (varicose veins) of the submucosal (below the mucosa) veins of the esophagus (food pipe). They are a consequence of portal hypertension (high pressure in the portal vein), which often occurs in the course of liver cirrhosis (liver shrinkage).
Esophageal varices have very thin walls and can rupture (tear) quickly. Even physical exertion such as lifting heavy loads or coughing causes an increase in pressure in the veins. Esophageal variceal bleeding is a life-threatening complication!
A distinction is made between:
- Esophageal varices with bleeding – ICD-10-GM I85.0
- Esophageal varices without bleeding – ICD-10-GM I85.9
In the setting of portal hypertension, due to advanced-stage liver cirrhosis, esophageal varices are detectable in approximately 50% of affected individuals. Every patient with liver cirrhosis should be examined regularly for the presence of esophageal varices.
The incidence (frequency of new cases) for esophageal variceal hemorrhage is approximately 5% per year or 30% when the so-called “cherry red spots” are detected on the mucosa (mucous membrane) of the esophagus.
Course and prognosis: Esophageal varices form without symptoms. They are usually not noticed until they rupture (rupture) and esophageal variceal bleeding occurs. The risk of esophageal variceal hemorrhage increases with the severity of liver damage. Within two years of diagnosis, approximately 25-40% of patients experience esophageal variceal hemorrhage, and some of these patients also develop gastric varices and gastropathia hypertensiva (dilatation of veins in the gastric mucosa caused by venous blood back-up due to increased blood pressure in the portovenous stroma).
Esophageal varices are often recurrent (recurring) because the cause usually cannot be corrected. Within the first 10 days after the first bleed, the risk of recurrent bleeding is 35%. Within one year of the first hemorrhage, the recurrence rate is 70%.
The lethality (mortality related to the total number of people with the disease) associated with the first hemorrhage is as high as 30%.Other causes of lethality are in severe liver cirrhosis or pneumonia (lung infection).
