Q: What is "downhill" esophageal varices?
Answer: Patients on permanent hemodialysis (HD) and upper-extremity access often develop superior vena cava (SVC) obstruction. This SVC obstruction leads to varices in the upper esophagus. It is called "downhill" esophageal varices because the direction of the blood flow is downwards. These varices can be reversed with SVC obstruction relief. Management in case of acute bleeding requires endoscopic band ligation or sclerotherapy.
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#vascular
References:
1. Blam ME, Kobrin S, Siegelman ES, Scotiniotis IA. "Downhill" esophageal varices as an iatrogenic complication of upper extremity hemodialysis access. Am J Gastroenterol 2002; 97:216.
2. Chandra A, Tso R, Cynamon J, Miller G. Massive upper GI bleeding in a long-term hemodialysis patient. Chest 2005; 128:1868.
3. Loudin M, Anderson S, Schlansky B. Bleeding 'downhill' esophageal varices associated with benign superior vena cava obstruction: case report and literature review. BMC Gastroenterol 2016; 16:134.
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