Esophageal varices bleeding usually don’t have symptoms at first, and only develop symptoms such as tarry stool or vomiting blood when it gets serious.
Treatment of esophageal venous aneurysm bleeding: drug treatment, Sengstaken-Blakemore tube, Esophagogastroduodenoscopy, and surgical treatment.
Care after treatment should include a bland diet, avoid fatigue and straining maneuvers, take medicine and return to the OPD for follow-up, attention to rebleeding signs.
I. What is esophageal varices?
Esophageal varices are a common and dangerous complication of liver cirrhosis. They are caused by portal hypertension. As portal pressure rises, the esophagogastric veins dilate and distend (Figure 1). These engorged and dilated veins are called varices. Esophageal varices can rupture and cause severe hemorrhage. They usually occur at the lower part of the esophagus.
(Image: Hand-drawn diagram)
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All information above has been reviewed by Gastroenterology specialists Edited and published by the Department of Nursing, Taichung Veterans General Hospital
II. What are the symptoms of bleeding esophageal varices? In the early stages, there are often no noticeable symptoms. However, if the bleeding becomes severe, patients may develop symptoms such as vomiting blood or passing black, tarry stools.
(Image generated by Gemini AI)
III. How to manage ruptured esophageal varices?
Medication Therapy:
Administer vasopressin (Glypressin/Sandostatin) to decrease portal pressure.
Sengstaken-Blakemore tube (SB tube):
Insert a Sengstaken-Blakemore tube to compress the bleeding varices. (Image: Hand-drawn diagram)
Esophagogastroduodenoscopy (EGD):
Inject a sclerosing agent (e.g., Histoacryl) during an endoscopy to cause venous thrombosis and fibrosis.
Wrap elastic bands around the esophageal varices during an endoscopy.
Surgical Treatment:
Due to advances in prophylactic endoscopic injection sclerotherapy and ligation, surgical treatment is rarely performed.
IV. Dietary Principles after esophageal varices bleeding: You must fast (take nothing by mouth) during the acute bleeding phase. Do not eat immediately following your treatment. Your healthcare team will assess your condition and tell you when it is safe to resume eating.
Once you start eating, please follow these guidelines:
Bland Diet: Non-irritating, easy to chew, and easy to digest.
Avoid irritating foods and beverages, such as alcohol, coffee, spicy, or sour foods.
Avoid fatigue
Maintain a regular lifestyle and a stable mood.
Avoid straining maneuvers
Ensure smooth bowel movements (at least once a day),avoid straining when passing stool, and pay attention to the color of stool.
Avoid violent coughing and heavy lifting.
Take medicine and follow up
Take medicine by doctor’s order.
Return to the clinic for your follow-up appointments after discharge.
Pay attention to rebleeding signs
If any of the following signs appear,go to the hospital immediately: fever, pale skin, rapid breathing,rapid heartbeat, agitation,black/tarry stools, or vomiting blood.
(Image generated by Gemini AI)
VI. Conclusion Esophageal varices require ongoing monitoring and repeated treatments. During this time, the risk of bleeding remains. To reduce the risk of rebleeding, patients should maintain a healthy lifestyle, take medications as prescribed, attend all follow-up appointments, and manage underlying conditions such as liver cirrhosis or tumors.
VII. Reference
Kaplan, D. E., Ripoll, C., Thiele, M., Fortune, B. E., Simonetto, D. A., Garcia-Tsao, G., & Bosch, J. (2024). AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis. Hepatology, 79(5), 1180–1211.
Singh, S., Chandan, S., Vinayek, R., Aswath, G., Facciorusso, A., & Maida, M. (2024). Comprehensive approach to esophageal variceal bleeding: From prevention to treatment. World Journal of Gastroenterology, 30(43), 4602–4608.
Taichung Veterans General Hospital. (2024). Patient dietary manual [病人飲食手冊]. Retrieved from https://reurl.cc/laqE3A