Introduction:

Gastric varices are dilated submucosal veins in the stomach, often associated with portal hypertension and liver cirrhosis. They are less common than esophageal varices but pose a significant risk for bleeding, which can be more severe and challenging to manage. This article aims to provide an in-depth understanding of gastric varices, including their causes, clinical presentation, diagnostic methods, and treatment options.

Etiology:

• Portal Hypertension: The primary cause, often due to liver cirrhosis.
• Splenic Vein Thrombosis: Can lead to isolated gastric varices, particularly in the fundus of the stomach.
• Other Causes: Include Budd-Chiari syndrome, congestive heart failure, and certain parasitic infections.

Clinical Presentation:

• Asymptomatic: Many patients are asymptomatic until a bleeding episode occurs.
• Gastrointestinal Bleeding: Manifested by hematemesis (vomiting blood), melena (black, tarry stools), or hematochezia (passage of fresh blood per rectum).
• Anemia: Chronic blood loss can lead to iron deficiency anemia.

Diagnosis:

• Endoscopy: Upper gastrointestinal endoscopy is crucial for diagnosis and classification of gastric varices.
• Imaging: Doppler ultrasound, CT scan, or MRI to assess the portal venous system and liver pathology.
• Laboratory Tests: Including liver function tests and complete blood count.

Management:

• Primary Prophylaxis: Non-selective beta-blockers may be used, although their efficacy in preventing bleeding from gastric varices is less clear than with esophageal varices.
• Acute Bleeding Management: Includes resuscitation, blood transfusions, and the use of vasoactive drugs. Endoscopic interventions like cyanoacrylate glue injection are preferred for bleeding gastric varices.
• Secondary Prophylaxis: After an initial bleeding episode, repeated endoscopic treatments or TIPS (Transjugular Intrahepatic Portosystemic Shunt) may be necessary to prevent rebleeding.
• Balloon-Occluded Retrograde Transvenous Obliteration (BRTO): An alternative treatment for patients with fundal varices and a competent gastrorenal shunt.

Complications:

• Bleeding: Gastric variceal bleeding can be more severe than esophageal variceal bleeding and more challenging to control.
• Infection: Increased risk after episodes of bleeding, especially in patients with liver cirrhosis.

Conclusion:

Gastric varices are a significant clinical concern in patients with portal hypertension, requiring diligent surveillance and management. The approach to managing gastric varices is multifaceted, involving endoscopic techniques, pharmacotherapy, and potentially interventional radiology procedures. Early detection and proactive management are key to preventing severe complications and improving patient outcomes.

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