1.First of all, let’s start with the bleeding esophageal varices. Under normal condition, there are only tiny blood vessels in the esophageal wall, under abnormal condition, these blood vessels show increased pressure, thickened lumen and dramatically increased blood flow, which leads to thickened, expanded and tortuous veins in the esophageal wall, forming esophageal varices. As the disease progresses, the esophageal varices gradually worsen, the lumen becomes larger and larger, and the vein wall becomes thinner and protrudes on the inner surface of the esophagus. When varices are severe, more than ten finger-thick veins climb on the esophageal wall and protrude into the lumen of the esophagus. These highly dilated veins are filled with blood, like a reservoir with water above the warning line, and are very dangerous and at risk of breaking down and bleeding at any time. The mechanism of formation of this disease is the same as that of varicose veins in the lower legs that we see in our daily life, both are caused by increased venous pressure, but they appear in different places. A further increase in venous pressure, combined with friction from food during eating, can cause the vein wall to rupture and bleed! In mild cases, there are symptoms such as black stools and dizziness, and in severe cases, the bleeding can be hundreds to thousands of milliliters, with vomiting of blood, dark red bloody stools, shock, and even death. Gastroscopic images, showing severely prominent esophageal varices. 2.What are the causes of esophageal varices? Normally, venous blood from the stomach and intestines passes through the portal vein and flows to the liver, where it is filtered and processed by the liver and then returns to the heart through the hepatic vein. When patients suffer from various liver diseases such as hepatitis B, hepatitis C, alcoholic liver disease, etc., the development of the disease can cause cirrhosis, resulting in a shrinking and hardening of the liver, increased resistance to portal vein flow to the liver, increased pressure, and eventually portal hypertension! When portal hypertension occurs, the large amount of blood flow in the portal vein is like a raging flood that cannot flow to the liver and finds its way everywhere in the closed system of the portal vein. The most common way out is through the veins around the esophagus and back to the heart. The constant flow of portal blood through the peri-esophageal veins increases the pressure in the lumen and opens up the venous lumen, eventually leading to esophageal varices. Diagram of esophageal varices 3.How to diagnose esophageal varices? The methods to diagnose esophageal varices are barium swallow, gastroscopy and abdominal enhancement CT, which can be chosen according to the patient’s own condition. In patients with cirrhosis, esophageal varices should be detected early and dealt with reasonably. 4.How to deal with esophageal varices? Patients should not panic if they find esophageal varices. First of all, the diet should be careful to avoid eating raw, cold and hard food, and eat soft, mild and easy to digest food to prevent damage to the surface of esophagus. Secondly, ligation of varicose veins on the surface of esophagus can be considered through gastroscopy. However, the root cause of esophageal varices is portal hypertension. Although the varices are ligated by gastroscopy, the high pressure portal blood flow will still form varices in the rest of the esophageal wall, causing varices to recur and bleed again.