Oesophageal varices

• Prolonged and severe portal hypertension most commonly due to liver cirrhosis induces formation of collateral bypass channels through the coronary veins of the stomach into oesophageal subepithelial and submucosal layers eventually emptying into the azygous vein and the systemic circulation
• The increased pressure in the oesophageal plexus produces dilated tortuous vessels called varices
• Varices develop in 90% of cirrhotic patients and are more often associated with alcoholic cirrhosis
• Worldwide shistosomiasis is the most common cause of variceal bleeding

 

Morphology

• Tortuous dilated veins are within the distal oesophageal and proximal gastric submucosa
• There is irregular luminal protrusion of the overlying mucosa with superficial ulceration, inflammation or adherent blood clots

 

Clinical

• Usually no symptoms until they rupture causing massive haematemesis
• The fatality rate is 40% for each episode of bleeding
• In survivors there is a 90% chance of reoccurrence within a year