Prevention of the formation and growth of esophageal varices

Abstract

The formation of a collateral circulation is a direct consequence of portal hypertension. Various types of collateral circulation may develop during the course of the disease, but from a clinical point of view the most important is the gastroesophageal collateral circulation, which results in the formation of gastroesophageal varices. Varices are a very specific index of the presence of portal hypertension, but they are not sensitive, since patients with portal hypertension may develop collateral vessels other than esophageal varices. Once varices are formed, they progress from small to large, and eventually bleed. The risk of bleeding increases according to the size of the varices, the presence of red marks, and the severity of the underlying liver disease. Available strategies for preventing variceal formation and growth, with the aim of decreasing the risk of variceal bleeding, are discussed based on the available evidence.