• Dilated collateral veins in the lamina propria of the distal esophagus connecting the portal and systemic circulations
• Results from chronic hypertension in the portal circulation due to increased resistance to blood flow
• Increased pressure and turbulent flow within these vessels as well as their superficial location in the distal esophagus make them prone to rupture with significant morbidity and mortality

Epidemiology

• Esophageal varices occur in ~50% of patients with cirrhosis.
• 50% of patients with esophageal varices bleed during their lifetime.
• Bleeding from esophageal varices is associated with 15–20% mortality.
• Predominant sex: Male > Female.

Risk Factors

Cirrhosis of the liver

Genetics
No known pattern

General Prevention

• Endoscope esophagus annually in patients with cirrhosis
• Consider use of non-selective beta-blockers or obliteration of varices with esophageal banding for those intolerant of medication to prevent bleeding

Pathophysiology

Portal Hypertension is caused by elevated portal pressure due to splanchnic arteriolar vasodilatation and increased resistance through dilated hepatic sinusoids.

Etiology

• Portal Hypertension is defined as a pressure gradient >10 mmHg.
• Cirrhosis accounts for >90% of cases. Alcohol and hepatitis C are the most common etiologies.
• Hemochromatosis, hepatitis B, nonalcoholic fatty liver disease, biliary cirrhosis, and autoimmune cirrhosis account for remainder. Extrahepatic portal vein thrombosis from umbilical vein infection, trauma, chronic pancreatitis, thrombotic conditions, and polycythemia.
• Malignant invasion of liver sinusoids or portal vein; seen in lymphoma, leukemia, hepatocellular carcinoma, and pancreatic carcinoma.
• Metabolic diseases altering liver sinusoids—amyloid, Gaucher disease, fatty liver
• Budd-Chiari syndrome
• Veno-occlusive disease

Commonly Associated Conditions

• Portal hypertensive gastropathy
• Hemorrhoids