'downhill' esophageal varices

Q: "Downhill" esophageal varices are mostly due to? - select one

A) End Stage Liver Disease (ESLD)

B) End Stage Renal Disease (ESRD)

Answer: B

Some patients with ESRD who are on hemodialysis may develop upper esophagus varices. These are called "downhill" esophageal varices because the direction of the blood flow is downwards. These varices are secondary to superior vena cava (SVC) obstruction resulting from the creation of upper-extremity hemodialysis access.

These patients are usually asymptomatic, but in case of recurrent or severe upper GI bleeding, treatment of the underlying SVC obstruction may be required. Symptomatic treatment remains the same with endoscopic variceal band ligation or sclerotherapy at the proximal end of the varix.

#vascular

#GI

#nephrology

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.