Year 2016 / Volume 108 / Number 7
Case Report
Downhill varices: an uncommon cause of upper gastrointestinal bleeding

440-442

DOI: 10.17235/reed.2015.3697/2015

Guillermo Ontanilla Clavijo, Claudio Trigo Salado, Norberto Rojas Mercedes, Juan Antonio Caballero Gómez, Adalberto Rincón Gatica, Juan Manuel Alcívar-Vasquez, José Luis Márquez Galán,

Abstract
Background: Upper gastrointestinal bleeding (UGIB) is a common condition in gastroenterology, but "Downhill Varices" (DHV) or varices of the upper oesophagus are an uncommon cause of UGIB, with different aetiology from lower third oesophageal varices and different therapeutic implications. Case report: A 28-year-old male patient, with a history of chronic kidney failure secondary undergoing haemodialysis and superior vena cava syndrome (SCVS) due to multiple catheter replacements, was admitted to the Emergency Department with haematemesis secondary to a varicose vein rupture in the proximal third of oesophagus, treated initially with ethanolamine. Subsequent diagnostic studies showed the collateral circulation secondary to the SCVS. No further endoscopic or endovascular therapy could be performed and the patient will finally undergo a surgical bypass. Discussion: DHVs are a very uncommon condition and endoscopic band ligation emerges as the appropriate therapeutic approach for the bleeding event. The definitive therapy continues to be that for the cause of the SVCS.
Share Button
New comment
Comments
No comments for this article
References
1 – Felson B, Lessure AP. “Downhill” varices of the esophagus. Dis Chest 1964; 46:740-6.
2 - Tanaka H, Nakahara K, Goto K. Two cases of "downhill"esophageal varices associated with superior vena cava to lung cancer. Nihon Kyobu Shikkan Gakkai Zasshi 1991; 29: 1484-88.
3 - Fleig WE, Stange EF, Ditschuneit H. Upper gastrointestinal hemorrhage from "downhill" esophageal varices. Dig Dis Sci 1982; 27: 23-7.
4 - Bos GM, Saleh A, Schouten HC, et al. "Downhill" oesophagus varices: a clue to a serious disease. Neth J Med 1992; 40: 27-30.
5 - Yasar B, Abut E. A case of mediastinal fibrosis due to radiotherapy and 'downhill' esophageal varices: a rare cause of upper gastrointestinal bleeding. Clin J Gastroenterol 2015;8:73-6.
6 – Pop A, Cutler AF. “Bleeding downhill esophageal varices: a complication of upper extremity hemodialysis access,” Gastrointest Endosc 1998; 47: 299-303.
7 - Blam ME, Kobrin S, Siegelman ES, et al. “Downhill” esophageal varices as an iatrogenic complication of upper extremity hemodialysis access. Am J Gastroenterol 2002; 97: 216-8.
8 - Lutisan JG, Ploem S, Zijlstra JG. Bleeding noncirrhotic fundus (“downhill”) varices in a patient on chronic intermittent hemodialysis. Eur J Intern Med 2006; 17: 586.
9 - Ennaifer R, B'chir Hamzaoui S, Larbi T, et al. Downhill oesophageal variceal bleeding: A rare complication in Behçet's disease-related superior vena cava syndrome. Arab J Gastroenterol 2015 Mar 17. pii: S1687-1979(15)00005-2. doi: 10.1016/j.ajg.2015.02.003. [Epub ahead of print]
10 - Areia M, Romãozinho JM, Ferreira M, et al. “Downhill” varices. A rare cause of esophageal hemorrhage. Rev Esp Enferm Dig 2006; 98: 359-61.
11 - Heller SK, Meyer JR, Russell EJ. Spinal cord venous infarction following endoscopic sclerotherapy for esophageal varices. Neurology 1996; 47: 1081–5.
12 - Tsokos M, Bartel A, Schoel R, et al. Fatal pulmonary embolism after endoscopic embolization of "downhill" esophageal varix. Dtsch Med Wochenschr 1998; 123: 691-5.
13 - Maton PN, Allison DJ, Chadwick VS. "Downhill" esophageal varices and occlusion of superior and inferior vena cavas due to a systemic venulitis. J Clin Gastroenterol 1985; 7: 331-7.
14 – Tavakkoli H, Asadi M, Haghighi M, et al. Therapeutic approach to "downhill" esophageal varices bleeding due to superior vena cava syndrome in Behcet's disease: a case report. BMC Gastroenterol. 2006; 6: 43
Related articles

Letter

Upper gastrointestinal bleeding and Rigler triad

DOI: 10.17235/reed.2023.9731/2023

Letter

A full hemostatic repertoire in a complex cirrhotic patient

DOI: 10.17235/reed.2022.9039/2022

Digestive Diseases Image

Bezoar: an uncommon cause of upper gastrointestinal bleeding

DOI: 10.17235/reed.2021.8311/2021

Letter

COVID-19 and aorto-enteric fistula

DOI: 10.17235/reed.2021.8272/2021

Letter to the Editor

Gangliocytic paraganglioma: an unusual cause of upper gastrointestinal bleeding

DOI: 10.17235/reed.2017.4808/2016

Citation tools
Ontanilla Clavijo G, Trigo Salado C, Rojas Mercedes N, Caballero Gómez J, Rincón Gatica A, Alcívar-Vasquez J, et all. Downhill varices: an uncommon cause of upper gastrointestinal bleeding. 3697/2015


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 737 visits.
This article has been downloaded 160 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 21/01/2015

Accepted: 29/04/2015

Online First: 15/09/2015

Published: 11/07/2016

Article revision time: 91 days

Article Online First time: 237 days

Article editing time: 537 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology