What are Gastric Varices?

Gastric varices are dilated submucosal veins in the stomach, similar to esophageal varices, which can lead to serious and life-threatening bleeding. This condition is most commonly associated with portal hypertension, often resulting from liver cirrhosis. Understanding the causes, symptoms, types, and treatments of gastric varices is crucial for managing this complex condition.

Types of Gastric Varices

Gastric varices are classified based on their location and morphology. The two primary types are:

Gastroesophageal Varices (GOV)

Gastroesophageal varices are continuous with esophageal varices and extend into the stomach. They are further divided into:

GOV1: These are lesser curve varices that extend from the esophagus into the stomach.
GOV2: These are varices that extend from the esophagus into the greater curvature of the stomach.

Isolated Gastric Varices (IGV)

Isolated gastric varices are not continuous with esophageal varices and are found solely in the stomach. They are categorized into:

IGV1: Located in the fundus of the stomach.
IGV2: Located anywhere in the stomach except the fundus.

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Causes of Gastric Varices

The primary cause of gastric varices is increased pressure in the portal vein, known as portal hypertension. This pressure is often a consequence of liver diseases, such as cirrhosis, which hinder normal blood flow through the liver. Other conditions that might contribute to the development of portal hypertension include thrombosis in the portal vein, schistosomiasis, and congenital hepatic fibrosis.

Underlying Liver Diseases

Liver cirrhosis is the most common underlying condition leading to gastric varices. This chronic liver disease is characterized by the replacement of healthy liver tissue with scar tissue, which obstructs blood flow and increases portal vein pressure.

Portal Vein Thrombosis

Thrombosis, or blood clotting in the portal vein, can also cause increased pressure, leading to the formation of varices. This condition might be associated with hypercoagulable states, malignancies, or inflammatory conditions.

Symptoms of Gastric Varices

Symptoms of gastric varices may not be apparent until bleeding occurs, which can be severe and life-threatening. Common symptoms include:

Hematemesis: Vomiting blood, which may appear bright red or like coffee grounds.
Melena: Black, tarry stools due to digested blood.
Anemia: Resulting from chronic blood loss.
Hypotension: Low blood pressure due to significant blood loss.
Shock: Severe cases can lead to hypovolemic shock, a medical emergency.

Diagnosis of Gastric Varices

Diagnosing gastric varices typically involves a combination of clinical evaluation, endoscopic examination, and imaging studies.

Endoscopy

Endoscopy is the gold standard for diagnosing gastric varices. During this procedure, a flexible tube with a camera ( endoscope) is inserted through the mouth to visualize the esophagus and stomach. This allows for direct observation of varices and any active bleeding.

Imaging Studies

Imaging studies, such as Doppler ultrasound, CT scan, and MRI, can help assess portal vein pressure and detect any underlying liver conditions contributing to varices.

Laboratory Tests

Laboratory tests, including liver function tests, complete blood count, and coagulation profile, provide additional information about the patient’s overall health and liver function.

Treatments for Gastric Varices

Treatment options for gastric varices focus on preventing bleeding, controlling active bleeding, and addressing the underlying cause of portal hypertension.

Preventive Treatments

Preventive treatments aim to reduce the risk of bleeding in patients with diagnosed gastric varices.

Beta-Blockers: Non-selective beta-blockers, such as propranolol and nadolol, can reduce portal pressure and the risk of variceal bleeding.
Endoscopic Variceal Ligation (EVL): This procedure involves the placement of rubber bands around varices to reduce their size and prevent bleeding.

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Emergency Treatments for Bleeding

In the event of active bleeding, immediate medical intervention is required.

Endoscopic Treatments: Endoscopic techniques, such as band ligation and sclerotherapy, can be used to control bleeding.
Terlipressin: This vasopressin analogue constricts blood vessels and reduces portal pressure, helping to control bleeding.
Transjugular Intrahepatic Portosystemic Shunt (TIPS): TIPS is a procedure that creates a channel within the liver to redirect blood flow and reduce portal pressure.

Glue Injection in Gastric Varices

Glue injection, or cyanoacrylate injection, is a highly effective treatment for bleeding gastric varices. This procedure involves injecting a medical adhesive directly into the varices, causing them to harden and stop bleeding. Glue injection is particularly useful for fundal varices, which are often difficult to manage with other endoscopic techniques.

Long-term Management

Long-term management of gastric varices involves regular monitoring and addressing the underlying cause of portal hypertension. This might include:

Liver Transplantation: For patients with advanced liver disease, liver transplantation may be the only definitive treatment.
Regular Endoscopic Surveillance: Periodic endoscopic examinations to monitor varices and intervene before bleeding occurs.

Prevention of Gastric Varices

Preventing gastric varices primarily involves managing the underlying causes of portal hypertension and liver disease.

Lifestyle Modifications

Patients are advised to avoid alcohol, maintain a healthy weight, and follow a liver-friendly diet. These modifications can help manage liver disease and reduce the risk of developing varices.

Medical Management

Managing conditions that contribute to portal hypertension, such as hepatitis, is crucial. Antiviral medications, lifestyle changes, and regular medical follow-ups can help control liver disease progression.

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