Esophageal Varices

Question: Is there any treatment for the esophageal varices? I am 460 lbs. I have Type II non-insulin dependant Diabetes, hypertension, obstructive sleep apnea, and hypersplenia. I was scheduled for Gastric Bypass surgery on April 5th, 2007 but they aborted the operation due to the esophageal varices. The GI specialist that my bariatric surgeon sent me to says there in NO TREATMENT. Yet my surgeon will not allow a second opinion. Please leave any advice you have.

Answer: The treatment for esophageal varices is directed immediately to control the bleeding, and then long-term medical therapy. Immediate control of bleeding is usually performed by endoscopic means. In fact, bleeding can be initially controlled in approximately 90 percent of cases. However, the failure rate for endoscopic therapy is between 10 and 30 percent. Thus, longer term therapy is required in order to prevent a patient from bleeding. Variceal hemorrhage stops spontaneously in approximately 62 to 70 percent cases. However, recurrent bleeding occurs in 40 percent of patients within the next 72 hours. In fact, 60 percent of patients will rebleed within seven days of their initial bleeding. Although this type of bleeding will stop, it is the high rebleeding rate and the complications from acute hemorrhage which make control of bleeding mandatory in both the initial period of the variceal bleed and the chronic state after the patient has been stabilized. Variants of esophageal varices are gastric varices. Gastric varices are dilated blood vessels that are found predominantly in the stomach. The true incidence of gastric varices is unknown. However, investigators have reported a wide incidence ranging between 20 and 70 percent in patients with esophageal varices. When gastric varices are identified without coexisting esophageal varices, a splenic vein thrombosis may be present. Another variant of portal hypertension is portal hypertensive gastropathy. It is present in 50 percent of patients with portal hypertension. These patients have dilated arterioles and venules (small veins). This abnormality is seen usually in the fundus and cardia of the stomach (approximately 2/3 of the stomach). It is rarely seen in the antrum (last 1/3) of the stomach. It appears to have a "snake skin " or "reticulated" appearance. Long-term treatment of portal gastropathy and gastric varices is with beta-blockers. They usually take the form of propranolol, a nonselective beta-blocker. These medications allow the pressure within the veins to be decreased, thus reducing the chance that bleeding will occur. Increased incidence of portal hypertensive gastropathy is noted in patients who undergo sclerotherapy for esophageal varices in the past. Other treatments for upper GI bleeding associated with esophageal varices include vasopressin, vasopressin with nitroglycerin, somatostatin, balloon tamponade, TPSS (transhepatic portosystemic shunt), transhepatic catheter embolization, shunt surgery, gastric stapling and sclerotherapy with or without any. =]

Question: How long do the bands last after esophageal varices surgery. Do you have to have them replaced?

Answer: Mmmm. Don't have to routinely have them "replaced" like changing oil on a car. But rates of re-bleeding requiring further endoscopic intervention is common. Endoscopic therapies (banding, sclerotherapy, etc) are just temporary fixes in a lot of cases, though. If someone has portal hypertension that is causing the varices, that has to be dealt with in another fashion. Historically there have been several options. One is surgery, either doing a selective shunt (splenorenal shunt) or nonselective shunt (portocaval) or a gruesome devascularization procedure. Another option is to have an interventional radiologist do a TIPS procedure (transjugular intrahepatic portocaval shunt). Or, if end-stage cirrhosis is the problem, transplant is an option.

Question: can you tell me about esophageal varices? were can i find info about esophageal... can they be healed or treated...

Answer: Esophageal varices are an outpouching of blood vessels in the esophageus. They are treatable, with various procedures.

Question: can you have gastric bypass surgery if you have esophageal varices and cirroisis of the liver?

Answer: you couldnt get the gastric bypass which is a bypass made around the stomach but u can get what i had and thats the gastic stapling aka lap band. They take your stomach and put a band around the top tip of it so that not as much food can enter you will have to get your gallbadder removed but it shouldnt harm anything elese because everything else is still the same where as it wouldnt be if you got gastric bypass. Did i help

Question: what are esophageal varices?

Answer: In medicine (gastroenterology), esophageal varices are extreme dilations of sub-mucosal veins in the mucosa of the esophagus in diseases featuring portal hypertension, secondary to cirrhosis primarily. Esophageal varices seven days post banding, showing ulceration at the site of banding.Patients with esophageal varices have a strong tendency to develop bleeding. Esophageal varices are diagnosed with endoscopy. Contents [hide] 1 Pathogenesis 2 Treatment and the role of endoscopy 3 Prevention 4 References 5 See also [edit] Pathogenesis The lower esophagus is a site of 'portosystemic anastamosis', meaning that venous blood flow in the portal circulation (i.e. draining into the portal vein) and the mesenteric circulation freely mix. In situations where portal pressures increase, which are typically related to cirrhosis, there is dilation of veins in the anastamosis, leading to esophageal varices. Varices can also form in other areas of the body, including the stomach (gastric varices), duodenum (duodenal varices), and rectum (rectal varices). Treatment of these types of varices may differ. [edit] Treatment and the role of endoscopy In emergency situations, the care is directed at stopping blood loss, maintaining plasma volume, correcting disorders in coagulation induced by cirrhosis, and appropriate use of antibiotics (as infection is either concomittant, or a precipitant). Therapeutic endoscopy is considered the mainstay of urgent treatment. Two main therapeutic approaches exist: Variceal ligation, or banding sclerotherapy In cases of refractory bleeding, balloon tamponade may be necessary, usually as a bridge to further endoscopy, a transjugular intrahepatic portosystemic shunt (TIPS), or a distal splenorenal shunt procedure or a liver transplantation. [edit] Prevention Ideally, patients with known varices should receive treatment to reduce their risk of bleeding (Lebrec et al., 1981). The non-selective β-blockers (e.g., propranolol, timolol or nadolol) and nitrates have been evaluated for secondary prophylaxis. The effectiveness of this treatment has been shown by a number of different studies (Talwalkar JA & Kamath PS, 2004). Unfortunately, non-selective β-blockers do not prevent the formation of esophageal varices (Groszmann RJ et al., 2005).

Question: pathophysilogy diagram of esophageal varices?

Answer: Please see the web page for more details and images on Esophageal varices

Question: Varices and weight loss? Does anyone know of a good way to lose weight with esophageal varices? For those who do not know what varices are, when my body is under too much strain or pressure (for example weight lifting or stress) my vein in my esophagus can burst and cause internal bleeding. I really want to exercise though. >__< I don't want to lose weight and have flabby skin. Dieting doesn't really give me much in the way of results. I am 5'5 and 210 pounds. I have 4th stage primary biliary cirrhosis and I am 23. I'd like to lose at least 30 pounds.

Answer: Do you get routinely checked via endoscopy to get your varix banded? This will greatly reduce the risk of bleeding. I had PBC and a liver transplant. I had about 9 banded and never had a bleed. I also exercised regularly up till the day of my transplant.

Question: I Need Some Advice on what to do? I Haven't been able to enjoy my summer at all i am 20 yrs old and i have esophageal varices since i was a preme baby anyway i was in the hospital recently and when i got home my uncle passed away from a heart attack recently and it was sudden and now me and my brother are the only men that are left in the family.my life is a wreck i am about to throw in the towel a need some advice.

Answer: First of all don't throw no towel in. Life ain't about one summer ...it's about many summers. Can you even remember, everything you did 2 summers ago? Hospital stay and death of a loved one is the real matter at hand. Give yourself a break...at 20 yrs. old you have a lot of choices. You can't be the only one in your family that was effected by your uncle's death and your hospital stay. Try to start thinking about others around you and get yourself off your mind.

Question: SHould we make alcohol illegal? With all of the problems that alcohol causes, isn't it time that we make it illegal again? How can we let this stay legal? Why should our society put up with a bunch of drunks? Look at all the problems that alcohol causes. Liver disease Elevated liver enzyme levels Fatty liver, alcoholic hepatitis, cirrhosis Pancreatic disease Acute pancreatitis, chronic pancreatitis Cardiovascular disease Hypertension Cardiomyopathy, arrhythmias, stroke Gastrointestinal problems Gastritis, gastroesophageal reflux disease, diarrhea, peptic ulcer disease Esophageal varices, Mallory-Weiss tears Neurologic disorders Headaches, blackouts, peripheral neuropathy Alcohol withdrawal syndrome, seizures, Wernicke's encephalopathy, dementia, cerebral atrophy, peripheral neuropathy, cognitive deficits, impaired motor functioning Reproductive system disorders Fetal alcohol effects, fetal alcohol syndrome Sexual dysfunction, amenorrhea, anovulation, early menopause, spontaneous abortion Cancers Neoplasm of the liver, neoplasm of the head and neck, neoplasm of the pancreas, neoplasm of the esophagus Psychiatric comorbidities Depression, anxiety Affective disorders, anxiety disorders, antisocial personality Legal problems Traffic violations, driving while intoxicated, public intoxication Motor vehicle accidents, violent offenses, fires Employment problems Tardiness, sick days, inability to concentrate, decreased competence Accidents, injury, job loss, chronic unemployment Family problems Family conflict, erratic child discipline, neglect of responsibilities, social isolation Divorce, spouse abuse, child abuse or neglect, loss of child custody Effects on children Overresponsibility, acting out, withdrawal, inability to concentrate, school problems, social isolation Learning disorders, behavior problems, emotional disturbance We need to step up the War on Drugs to include alcohol. It has NO positive benefits on our society. NONE. It should be illegal.

Answer: I totally agree!! Marijuana should be legal instead!!

Question: What's wrong with our patient? 25 year old male admitted after coughing up blood and having bloody stool. Endoscopy revealed esophageal and rectal varices. Labs show elevated ALT and AST but negative for all strains of hepatitis virus. Patient experienced sudden onset of diabetes three months ago. Despite bleeding from varices, patient's level of iron remained consistently high, mostly bound to chelating proteins. Patient denies using alcohol regularly. What do we test for? Nope, tox screens are negative for presence of residual alcohol or acetaldehyde in the bloodstream. Friends also confirm his statement that he almost never drinks. Also alcohol use doesn't explain the sudden onset of diabetes. We know its liver disease, but what could be causing both his liver and pancreas to fail all of a sudden? Tox screens negative for use of drugs or alcohol. He's bleeding like crazy through his varices but his iron levels are through the roof.

Answer: Patient is likely lying about the alcohol use. Explains the diabetes, as the alcohol can cause liver problems. Liver problems are also indicated by the ALT and AST ... Liver disease I'd say Edit ... I still say Liver disease.