Esophageal Varices Guidelines: Best Practices 2023 Esophageal varices are abnormal, enlarged veins that develop in the lower part of the esophagus. They are often associated with portal hypertension, a condition in which there is increased pressure in the portal vein that carries blood from the digestive organs to the liver. Portal hypertension is commonly caused by liver cirrhosis. Esophageal varices can lead to serious complications, including bleeding, and require timely diagnosis and management.
In the following sections, we will delve into the various aspects of esophageal varices, starting with an understanding of what they are and how they are related to portal hypertension and liver cirrhosis. We will discuss the risk factors and complications associated with esophageal varices to provide a comprehensive overview of the condition.
Accurate diagnosis is crucial for effective management of esophageal varices. We will guide you through the different diagnostic methods and techniques used, including endoscopy, imaging tests, and bleeding risk assessments. With these tools, healthcare professionals can make informed decisions and develop personalized treatment plans for each patient.
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We believe that everyone deserves access to quality healthcare, which is why we have established multiple branches in strategic locations. Whether you're in need of routine check-ups, specialized treatments, or emergency care, ACIBADEM Health Point is here for you.Once diagnosed, proper management of esophageal varices is essential to prevent complications such as bleeding. We will explore the wide range of treatment options available, including medications, endoscopic therapies, and surgical interventions. With advancements in medical technology and techniques, healthcare providers can tailor treatment to each patient’s unique needs.
Prevention is always better than cure, and esophageal varices are no exception. We will discuss lifestyle modifications and medical interventions that can help prevent the development or worsening of varices, particularly in individuals at high risk. By adopting healthy habits and following the recommended protocols, individuals can significantly reduce their risk of developing esophageal varices.
Effective management of esophageal varices requires a collaborative approach involving a multidisciplinary team of healthcare professionals. We will shine a light on the role of gastroenterologists, hepatologists, surgeons, and other specialists in delivering comprehensive care to patients with esophageal varices.
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ACIBADEM Health Point, we are dedicated to providing exceptional healthcare services to our patients. With a team of highly skilled medical professionals and state-of-the-art facilities, we strive to deliver the highest standard of care to improve the health and well-being of our patients. What sets ACIBADEM Health Point apart is our patient-centered approach. We prioritize your comfort, safety, and satisfaction throughout your healthcare journey. Our compassionate staff ensures that you receive personalized care tailored to your unique needs, making your experience with us as seamless and comfortable as possible.In addition, we will touch upon the importance of long-term follow-up, regular monitoring, and potential future directions in esophageal varices management. Ongoing research aims to improve diagnostic techniques, treatment options, and preventive strategies based on the latest guidelines.
By the end of this guide, you will have a thorough understanding of the best practices for managing esophageal varices, as outlined in the 2023 guidelines. Whether you are a healthcare professional or an individual seeking reliable information, we are here to provide you with the knowledge and insights needed to make informed decisions about preventing, diagnosing, and managing esophageal varices.
Understanding Esophageal Varices
Before delving into the guidelines for managing esophageal varices, it is crucial to have a clear understanding of what they are and how they relate to portal hypertension. Esophageal varices are enlarged and swollen blood vessels in the esophagus, the muscular tube that connects the throat to the stomach. These varices can develop as a result of portal hypertension, a condition characterized by increased pressure in the portal vein, which carries blood from the intestines to the liver.
Portal hypertension is often caused by liver cirrhosis, a chronic liver disease characterized by scarring and damage to liver tissue. When liver function is compromised, blood flow through the liver becomes obstructed, leading to an increase in pressure within the portal vein. This increased pressure forces blood to seek alternative pathways, resulting in the formation of abnormal blood vessels, or varices, in the esophagus.
The presence of esophageal varices poses a significant risk for complications, primarily the risk of bleeding. These varices are fragile and prone to rupture, leading to severe and potentially life-threatening bleeding. It is estimated that up to 30% of patients with cirrhosis will develop esophageal varices, and the risk of bleeding increases with the size and severity of these varices.
Risk Factors for Esophageal Varices
Several factors can increase the likelihood of developing esophageal varices, including:
- Advanced liver cirrhosis
- Prolonged alcohol use
- Hepatitis B or C infection
- Obesity
- Male gender
- Older age
Monitoring these risk factors and being aware of their impact on the development and progression of esophageal varices is crucial for early detection and intervention.
Complications of Esophageal Varices
The main complication associated with esophageal varices is bleeding. When varices rupture, they can cause significant and life-threatening gastrointestinal bleeding. This bleeding can be sudden and profuse, resulting in symptoms such as vomiting blood, black or tarry stools, and lightheadedness.
It is essential to promptly diagnose and treat bleeding esophageal varices to prevent further complications, including:
- Hypovolemic shock (severe blood loss)
- Acute anemia
- Recurrent bleeding episodes
- Portal vein thrombosis
- Hepatic encephalopathy (changes in brain function due to liver dysfunction)
By understanding the risk factors and complications associated with esophageal varices, healthcare professionals can develop effective strategies for diagnosis, treatment, and prevention, as outlined in the guidelines for managing esophageal varices.
Diagnosis of Esophageal Varices
Accurate and timely diagnosis is crucial for effectively managing esophageal varices. Determining the presence, severity, and risk of bleeding requires a comprehensive diagnostic approach. Various methods and techniques are employed to assess esophageal varices and guide treatment decisions.
Endoscopy
Endoscopy is considered the gold standard for diagnosing esophageal varices. A flexible tube with a camera (endoscope) is passed through the mouth and into the esophagus to visualize the varices. The severity of varices is assessed using a grading system, such as the Baveno classification, which takes into account the size and appearance of the varices.
Imaging Tests
In addition to endoscopy, imaging tests such as abdominal ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) may be used to evaluate the liver, portal vein, and surrounding structures. These tests can provide valuable information about the underlying cause of varices, such as liver cirrhosis, and help guide treatment decisions.
Bleeding Risk Assessments
Assessing the risk of variceal bleeding is crucial in determining the appropriate management strategy. Several scoring systems, such as the Child-Pugh score and the Model for End-Stage Liver Disease (MELD) score, are used to assess the overall liver function and predict the risk of bleeding. These scores take into account factors such as liver function tests, bilirubin levels, and the presence of ascites or encephalopathy.
Furthermore, non-invasive tests like the transient elastography (FibroScan) can assess liver stiffness, providing valuable information about the extent of liver fibrosis and the risk of complications, including variceal bleeding.
By combining endoscopy, imaging tests, and bleeding risk assessments, healthcare professionals can make an accurate diagnosis, assess the severity of varices, and determine the appropriate management strategy for each individual patient. Early detection and appropriate intervention can help prevent complications and improve outcomes in patients with esophageal varices.
Management of Esophageal Varices
Once diagnosed, proper management of esophageal varices is essential to prevent complications such as bleeding. This section will discuss the different treatment options available, including medication, endoscopic therapies, and surgical interventions.
Treatment Options
- Medication: Medications play a crucial role in the management of esophageal varices. They are primarily used to reduce the risk of bleeding by decreasing portal pressure. The most commonly prescribed medications include beta blockers and vasoconstrictors.
- Endoscopic Therapies: Endoscopic interventions are commonly employed for the treatment of esophageal varices. These procedures aim to prevent bleeding or manage active bleeding. Endoscopic therapies include band ligation and sclerotherapy, where bands or sclerosing agents are used to stop bleeding and prevent future episodes.
- Surgical Interventions: In certain cases, surgical interventions may be necessary to manage esophageal varices. Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive procedure that creates a shunt between the portal vein and hepatic vein, reducing pressure in the varices. In severe cases, liver transplantation may be considered as a definitive treatment option.
It is important to note that the choice of treatment depends on various factors such as the severity of varices, presence of bleeding, underlying liver disease, and individual patient characteristics. A multidisciplinary approach involving gastroenterologists, hepatologists, and surgeons is often required to determine the most appropriate treatment plan.
Comparison of Treatment Options
| Treatment Option | Advantages | Disadvantages |
|---|---|---|
| Medication | – Non-invasive – Can be taken orally – Widely available |
– Side effects – Requires long-term use – May not be suitable for all patients |
| Endoscopic Therapies | – Effective in acutepisodes – Can prevent future bleeding – Minimal invasiveness |
– May require repeat procedures – Risk of complications |
| Surgical Interventions | – Can be curative – Long-term benefits – Suitable for severe cases |
– Invasive procedure – Potential complications – Limited availability |
Although each treatment option has its advantages and disadvantages, the ultimate goal is to prevent bleeding and reduce the risk of complications in patients with esophageal varices. The choice of treatment should be tailored to the individual patient’s condition and preferences, taking into account the advice of the healthcare team.
Prevention of Esophageal Varices
In order to prevent the development or worsening of esophageal varices, it is crucial to implement a combination of lifestyle modifications and medical interventions, especially for high-risk individuals. By taking proactive measures, individuals can significantly reduce their risk of experiencing the complications associated with esophageal varices.
Lifestyle Modifications
One of the key approaches to preventing esophageal varices is making lifestyle modifications that can help reduce the risk factors associated with their development. Some important lifestyle changes to consider include:
- Avoiding or limiting alcohol consumption: Excessive alcohol consumption can lead to liver damage and increase the risk of developing esophageal varices. Limiting alcohol intake can help reduce this risk.
- Maintaining a healthy weight: Obesity has been linked to an increased risk of liver disease, including cirrhosis, which can lead to esophageal varices. Maintaining a healthy weight through a balanced diet and regular exercise can help lower this risk.
- Eating a nutritious diet: Consuming a diet rich in fruits, vegetables, whole grains, and lean proteins can support liver health and reduce the risk of developing liver disease.
- Quitting smoking: Smoking can contribute to liver damage and impair overall cardiovascular health. Quitting smoking can significantly reduce the risk of developing esophageal varices.
Medical Interventions
In addition to lifestyle modifications, certain medical interventions can help prevent the development or progression of esophageal varices. These interventions may be recommended based on the individual’s risk factors and medical history. Some common medical interventions for esophageal varices prevention include:
- Beta blockers: These medications help lower blood pressure in the portal vein, reducing the risk of variceal bleeding.
- Vasoconstrictors: Vasoconstrictor medications can help constrict the blood vessels in the esophagus, reducing the risk of variceal bleeding.
- Screening and surveillance: Regular screening and surveillance of individuals at high risk for esophageal varices, such as those with liver cirrhosis, can help detect varices at an early stage when preventive measures can be implemented.
| Preventive Measure | Description |
|---|---|
| Lifestyle Modifications | Implementing changes in alcohol consumption, weight management, diet, and smoking habits to reduce the risk factors associated with esophageal varices. |
| Beta Blockers | Medications that lower blood pressure in the portal vein, reducing the risk of variceal bleeding. |
| Vasoconstrictors | Medications that constrict blood vessels in the esophagus, reducing the risk of variceal bleeding. |
| Screening and Surveillance | Regular screening and surveillance of high-risk individuals to detect esophageal varices at an early stage when preventive measures can be implemented. |
By adopting lifestyle modifications and considering appropriate medical interventions, individuals can take active steps towards preventing the development or worsening of esophageal varices. It is essential to consult with healthcare professionals to receive personalized guidance and ensure a comprehensive approach to prevention.
Collaborative Approach to Care
In the management of esophageal varices, a collaborative approach involving various healthcare professionals is essential for providing comprehensive care. At Acibadem Healthcare Group, our team of experts, including gastroenterologists, hepatologists, and surgeons, work together to ensure the best possible outcomes for patients.
Gastroenterologists play a crucial role in the diagnosis and initial management of esophageal varices. With their expertise in digestive diseases, they are equipped to perform endoscopic procedures, such as variceal band ligation, and monitor the progression of varices over time.
Hepatologists, on the other hand, specialize in the treatment of liver diseases, including cirrhosis, which is often a precursor to esophageal varices. They focus on managing the underlying liver condition, prescribing appropriate medications, and providing long-term care to prevent varices from worsening.
Surgeons may be involved in cases where surgical interventions are necessary, such as the placement of a transjugular intrahepatic portosystemic shunt (TIPS) or liver transplantation. These procedures can help alleviate portal hypertension and reduce the risk of bleeding from esophageal varices.
At Acibadem Healthcare Group, our multidisciplinary team collaborates closely to develop personalized treatment plans for each patient. By combining our expertise, we strive to improve outcomes and enhance the quality of life for individuals with esophageal varices.
Benefits of a Collaborative Approach
When healthcare professionals from different disciplines work together, it enables a holistic approach to care that considers the unique needs of each patient. By combining their specialized knowledge and skills, they can develop comprehensive treatment plans that address not only the varices but also the underlying conditions and associated risk factors.
Collaboration also fosters better communication and coordination between healthcare providers, leading to improved continuity of care. This ensures that patients receive seamless transitions between different aspects of their treatment, from diagnosis to follow-up care and monitoring.
Patient-Centered Care at Acibadem Healthcare Group
Acibadem Healthcare Group takes pride in providing patient-centered care throughout the management of esophageal varices. Our team values open communication, empathy, and shared decision-making to empower patients in their treatment journey.
By adopting a collaborative approach, we can optimize outcomes and improve the overall patient experience. Our team of experts works together to find the best solutions for each individual, keeping in mind their specific needs and preferences.
Continued Innovation and Research
Acibadem Healthcare Group is dedicated to staying at the forefront of medical advancements in the management of esophageal varices. We actively participate in research and clinical trials to explore new treatment modalities, diagnostic techniques, and preventive strategies.
Through ongoing collaboration with renowned institutions and experts in the field, we strive to contribute to the development of evidence-based guidelines and improve the outcomes for patients diagnosed with esophageal varices.
| Benefits of a Collaborative Approach | Patient-Centered Care at Acibadem Healthcare Group | Continued Innovation and Research |
|---|---|---|
| Improved diagnosis and treatment planning | Open communication and shared decision-making | Participation in research and clinical trials |
| Holistic care considering all aspects of the condition | Empathy and focus on the individual’s needs | Contribution to evidence-based guidelines |
| Enhanced coordination and continuity of care | Optimization of outcomes and patient experience | Ongoing exploration of new treatment modalities |
Lifestyle Modifications
Certain lifestyle factors can increase the risk of developing or exacerbating esophageal varices. Making some important lifestyle modifications can help reduce the risk and improve overall health. Here are some recommendations:
Alcohol Cessation
Excessive alcohol consumption is a known risk factor for esophageal varices. It can lead to liver damage and increase portal hypertension, which in turn, contributes to the development of varices. Quitting or reducing alcohol intake can significantly lower the risk. Seek support from healthcare professionals or support groups to aid in alcohol cessation.
Weight Management
Being overweight or obese puts additional pressure on the liver, leading to an increased risk of developing esophageal varices. Maintaining a healthy weight through regular exercise and a balanced diet can help alleviate this risk factor. Focus on consuming a variety of nutrient-rich foods, including fruits, vegetables, lean proteins, and whole grains, while avoiding excess sugar, saturated fats, and processed foods.
Dietary Changes
Avoiding certain foods that can aggravate liver damage and contribute to varices is crucial. Limit consumption of salt, which can cause fluid retention and worsen portal hypertension. Additionally, reducing the intake of red meat and processed foods can help minimize the risk. Opt for a diet rich in fiber, antioxidants, and vitamins, which can support liver health and reduce inflammation.
Smoking Cessation
Smoking tobacco has numerous detrimental effects on overall health, including liver function. It can exacerbate liver damage and increase the risk of developing esophageal varices. Quitting smoking or seeking professional help to quit can significantly reduce the risk and improve overall well-being.
Implementing these lifestyle modifications can not only reduce the risk of developing esophageal varices but also improve overall health outcomes. It is important to discuss these changes with a healthcare professional to ensure personalized guidance and support.
| Lifestyle Modification | Impact on Esophageal Varices Risk |
|---|---|
| Alcohol Cessation | Significantly reduces the risk by minimizing liver damage and portal hypertension. |
| Weight Management | Reduces pressure on the liver and lowers the risk of esophageal varices development. |
| Dietary Changes | Supports liver health, reduces inflammation, and minimizes the risk of varices. |
| Smoking Cessation | Reduces liver damage and decreases the risk of esophageal varices. |
Medication Management
Medications play a vital role in the comprehensive management of esophageal varices, particularly in preventing life-threatening bleeding episodes. These medications aim to reduce portal hypertension and prevent the progression and rupture of varices. Commonly used medications for esophageal varices management include beta blockers and vasoconstrictors.
Beta Blockers
Beta blockers, such as propranolol and nadolol, are frequently prescribed to patients with esophageal varices to lower portal pressure and reduce the risk of bleeding. These medications work by blocking the beta receptors in the heart and blood vessels, resulting in decreased heart rate and blood pressure. By decreasing portal pressure, beta blockers help to prevent the development of new varices and reduce the size of existing ones.
Vasoconstrictors
Vasoconstrictors, like octreotide and terlipressin, are another class of medications used in the management of esophageal varices. These drugs work by constricting the blood vessels, specifically those in the splanchnic circulation, thereby reducing portal pressure and the risk of variceal bleeding. Vasoconstrictors are commonly used in combination with endoscopic therapies for acute bleeding episodes or as a bridge therapy before definitive treatment.
It is important to note that medication management for esophageal varices should be tailored to each patient’s specific needs and medical history. The choice of medication, dosage, and duration of therapy will depend on various factors, including the severity of varices, underlying liver disease, and individual patient characteristics.
Monitoring and regular follow-up with healthcare providers are essential to assess the effectiveness of medication therapy and make any necessary adjustments. The combination of medication management with other therapeutic modalities, such as endoscopic therapies or surgical interventions, may be required for optimal outcomes.
| Medication Class | Examples | Mechanism of Action |
|---|---|---|
| Beta Blockers | Propranolol, Nadolol | Block beta receptors, reduce heart rate and blood pressure, lower portal pressure |
| Vasoconstrictors | Octreotide, Terlipressin | Constrict blood vessels, decrease portal pressure, reduce risk of variceal bleeding |
Endoscopic Therapies
In the management of esophageal varices, endoscopic interventions are commonly employed as both a preventive measure and a method of managing active bleeding. These procedures offer effective treatment options that can help alleviate the complications associated with esophageal varices.
Band Ligation
One of the endoscopic treatment options for esophageal varices is band ligation. This procedure involves the placement of small rubber bands around the varices. These bands cut off the blood supply to the varices, causing them to shrink and eventually fall off. Band ligation is widely used due to its effectiveness in preventing variceal bleeding.
Sclerotherapy
Sclerotherapy is another commonly performed endoscopic therapy for the treatment of esophageal varices. This procedure involves injecting a chemical solution directly into the varices, causing them to scar and seal off. The scar tissue helps prevent further bleeding and reduces the size of the varices. Sclerotherapy is often used as an alternative to band ligation or in combination with other treatments.
In some cases, a combination of different endoscopic therapies may be used based on the individual patient’s condition and the severity of the varices. These treatment options are usually well-tolerated and have a high success rate in managing esophageal varices.
Surgical Interventions
In certain cases, surgical interventions may be necessary for the effective treatment of esophageal varices. These procedures play a crucial role in managing varices and reducing the risk of complications. Let’s explore two common surgical interventions: transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation.
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
TIPS is a minimally invasive procedure that involves creating a shunt between the portal vein and the hepatic vein to redirect blood flow and reduce pressure in the varices. This procedure is performed under local anesthesia and imaging guidance.
TIPS has been shown to effectively alleviate symptoms such as bleeding and ascites in patients with esophageal varices. It helps to bypass the liver and improve blood flow, reducing the risk of variceal bleeding.
While TIPS is generally considered safe and effective, there are potential risks and complications associated with the procedure. These may include hepatic encephalopathy, shunt malfunction, and liver damage.
Liver Transplantation
In severe cases of esophageal varices, where the liver is significantly damaged, liver transplantation may be the recommended surgical intervention. This procedure involves replacing the damaged liver with a healthy liver from a deceased or living donor.
Liver transplantation not only addresses the underlying cause of the varices (such as liver cirrhosis) but also eliminates the risk of variceal bleeding and other associated complications. However, it is worth noting that liver transplantation is a major surgery with potential risks and long-term implications.
Patients undergoing liver transplantation require lifelong immunosuppressive medication to prevent organ rejection and regular follow-up with a transplant team.
It is important to note that surgical interventions like TIPS and liver transplantation are typically reserved for cases where other treatment options have been unsuccessful or where there is a high risk of complications. The decision to undergo surgery is made on an individual basis, considering various factors such as the severity of the varices, overall health, and patient preferences.
| Surgical Intervention | Procedure | Benefits | Risks and Complications |
|---|---|---|---|
| Transjugular Intrahepatic Portosystemic Shunt (TIPS) | Creation of a shunt between the portal vein and hepatic vein | – Reduces pressure in varices – Alleviates symptoms – Minimally invasive procedure |
– Hepatic encephalopathy – Shunt malfunction – Liver damage |
| Liver Transplantation | Replacement of damaged liver with a healthy liver | – Addresses underlying liver disease – Eliminates risk of variceal bleeding – Improves overall health |
– Surgical complications – Organ rejection – Long-term immunosuppressive medication |
Long-Term Follow-up and Monitoring
Effective management of esophageal varices requires long-term follow-up and careful monitoring to prevent complications and evaluate the efficacy of treatment. Regular check-ups, endoscopic surveillance, and imaging studies play a vital role in ensuring the well-being of individuals with varices.
The Importance of Regular Check-ups
Regular check-ups are crucial for patients with esophageal varices. During these appointments, healthcare professionals can monitor the progression of varices, assess any changes in their size or severity, and identify the need for adjustments to the treatment plan. Additionally, check-ups provide an opportunity to address any concerns or symptoms that the patient may have, ensuring timely intervention when necessary.
Endoscopic Surveillance
Endoscopy is an essential tool for surveillance and monitoring of esophageal varices. It allows healthcare providers to visualize the varices directly and identify any signs of bleeding or progression. Depending on the severity of the varices, the frequency of endoscopic surveillance may vary, with more frequent examinations recommended for individuals at higher risk of complications.
Imaging Studies
In addition to endoscopy, imaging studies, such as ultrasound or computed tomography (CT), may be used to evaluate the extent and severity of esophageal varices. These non-invasive imaging modalities can provide valuable information about the size, location, and characteristics of the varices, aiding in the monitoring and management process. Imaging studies may be particularly useful for assessing the response to treatment or detecting any complications that may not be evident during an endoscopic examination.
Collaborative Care and Patient Education
Long-term follow-up and monitoring of esophageal varices require a collaborative approach involving healthcare professionals and the patient. It is essential to educate individuals with varices about the importance of regular check-ups, the signs and symptoms to watch out for, and the need for compliance with the treatment plan. Empowering patients with knowledge enhances their ability to participate actively in their own care, leading to improved outcomes and a reduced risk of complications.
By implementing a comprehensive follow-up and monitoring strategy, healthcare providers can optimize the management of esophageal varices, detect any early signs of complications, and ensure appropriate interventions are implemented in a timely manner.
Future Directions and Research
In the ever-evolving field of esophageal varices management, ongoing research and the latest guidelines for 2023 are paving the way for future directions in diagnosis, treatment, and prevention. These efforts aim to enhance patient outcomes and further refine the care provided to individuals with esophageal varices.
One area of focus for future research is the improvement of diagnostic techniques. Researchers are exploring novel methods that can accurately detect and assess the severity of esophageal varices. This includes advancements in imaging technology and the development of non-invasive diagnostic tools, reducing the need for invasive procedures and improving patient comfort.
Another important area of research revolves around expanding the range of treatment options available for esophageal varices. Ongoing studies are evaluating the effectiveness and safety of innovative therapies, such as tissue-engineered constructs and targeted drug delivery systems. These advancements have the potential to revolutionize how we manage esophageal varices, offering tailored and more personalized approaches to treatment.
Additionally, efforts are being made to optimize preventive strategies for esophageal varices. Research is focused on identifying individuals at high risk of developing varices and implementing targeted interventions to mitigate their progression. This includes exploring the role of genetic markers and other risk factors in predicting the development of varices, enabling early intervention and potentially preventing complications.
FAQ
What are esophageal varices?
Esophageal varices are abnormally enlarged veins in the lower part of the esophagus, usually resulting from increased pressure in the portal vein system, known as portal hypertension. They are commonly associated with liver cirrhosis.
What are the risk factors for developing esophageal varices?
The main risk factor for esophageal varices is liver cirrhosis, which can be caused by chronic alcohol abuse, viral hepatitis, or other liver diseases. Other risk factors include a history of bleeding or infection, advanced age, and male gender.
How are esophageal varices diagnosed?
The diagnosis of esophageal varices is typically made through endoscopy, a procedure in which a flexible tube with a camera is inserted into the esophagus to visualize the veins. Additional tests, such as imaging studies and bleeding risk assessments, may also be performed.
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