Varix

Varix, in its medical sense, refers to a dilated, tortuous vein. The term is most commonly used for veins that enlarge as a result of increased venous pressure, a condition known as varices in the plural. The most clinically important varices occur in the esophagus and stomach, but varices can form in other parts of the venous system as well.

Most esophageal and gastric varices develop in the setting of portal hypertension, often due to liver cirrhosis. When blood flow through the liver is impeded, collateral vessels form to bypass the blockage. These collateral veins become enlarged and their walls are thin, making them prone to rupture. Varices can be asymptomatic until they bleed, which may cause sudden, potentially life-threatening gastrointestinal hemorrhage. Less commonly, varices may occur in the rectum or elsewhere where portal-systemic connections exist.

Diagnosis typically involves endoscopic examination to identify and assess the size of varices, with imaging and Doppler studies used to evaluate portal pressure and liver disease. Management aims to prevent first bleeding in high-risk varices and to control active bleeding if it occurs. Primary prophylaxis may include nonselective beta-blockers or endoscopic band ligation for large varices. In acute bleeding, treatment combines resuscitation, antibiotics if infection is suspected, and vasoactive drugs to reduce portal pressure, along with endoscopic therapy such as ligation or, for gastric varices, glue injections. Rebleeding risk is mitigated by ongoing therapies and sometimes by procedures such as transjugular intrahepatic portosystemic shunt (TIPS) in refractory cases. Ongoing management focuses on treating underlying liver disease and monitoring for complications.