Esophageal varices are enlarged veins in the lower part of the esophagus, the tube connecting the throat and stomach. These varices form when normal blood flow to the liver is blocked, often due to scar tissue or a clot in the liver. To bypass these blockages, blood flows into smaller, more fragile blood vessels that are not designed to handle large volumes of blood. This leads to the development of swollen veins, or varices, in the esophagus. The increased pressure in the blood vessels of the liver is the primary cause of this condition.
Understanding Esophageal Varices
The portal system includes veins from the stomach, intestines, spleen, and pancreas, all merging into the portal vein that leads to the liver. Liver damage can block these blood vessels, increasing blood pressure within the portal system. This portal hypertension forces blood to be rerouted into smaller veins, which can result in large, swollen varices in the esophagus, stomach, rectum, or umbilical area.
Causes of Esophageal Varices
Several factors can lead to the development of esophageal varices:
- Cirrhosis: Scarring of the liver, often caused by conditions like hepatitis, alcoholic liver disease, fatty liver disease, and bile duct disorders.
- Blood Clots: Thrombosis can block blood flow to the liver, leading to increased pressure.
- Parasitic Infections: Schistosomiasis, a parasitic infection found in certain regions, can also contribute.
- High Portal Vein Pressure: Elevated pressure in the portal vein increases the risk of varices.
- Severe Cirrhosis or Liver Failure: Advanced liver disease significantly increases the likelihood of developing varices.
Symptoms and Diagnosis
Esophageal varices often don't cause symptoms unless they begin to bleed. If bleeding occurs, it is a medical emergency. A healthcare professional may use an endoscope to examine the esophagus and upper intestines. An endoscope is a flexible tube with a light and camera on the end. Doctors may diagnose bleeding esophageal varices by inserting a tube through the nose into the stomach to detect blood. Another method is an esophagogastroduodenoscopy (EGD), using a flexible tube with a camera to view the upper gastrointestinal system.
Dietary Recommendations for Managing Esophageal Varices
Dietary changes are essential in managing esophageal varices, especially for those with liver disease. The primary goals are to prevent further liver damage, minimize the risk of bleeding, and ensure adequate nutrition.
Read also: The Hoxsey Diet
General Dietary Guidelines
- Avoid Alcohol: Because alcohol is processed in the liver, eliminating alcohol consumption is crucial.
- Eat a Healthy Diet: Choose a diet rich in fruits, vegetables, whole grains, and lean protein sources.
- Maintain a Healthy Weight: Excess body fat can damage the liver, so maintaining a healthy weight is important.
- Limit Exposure to Toxins: The liver removes toxins from the body, so reducing exposure to chemicals in household products and the environment is beneficial.
The Esophageal Soft Food Diet
When irritation occurs in the throat or lower chest when eating certain foods or following a medical procedure, an easily digestible esophageal soft food diet may be necessary to make eating easier. This diet focuses on foods that are easy to swallow and digest, reducing the risk of irritation or damage to the esophagus.
- Texture: It is important that foods consumed be smooth in texture to facilitate the movement of food through the swollen areas of the esophagus or stomach.
- Breads and Grains: Consume all fruit juices; all baked, canned, cooked fruit (without seeds, membranes or tough skins), fresh ripe banana, peeled ripe apricot, peach, nectarine, and pear.
- Fruits: Opt for soft, cooked, or canned fruits without seeds or tough skins. Good choices include:
- All fruit juices.
- Baked, canned, or cooked fruit (without seeds, membranes, or tough skins).
- Fresh ripe bananas.
- Peeled ripe apricots, peaches, nectarines, and pears.
- Meats: Select well-cooked, tender, lean meats that are easy to chew and swallow.
- Well-cooked tender lean beef, veal, lamb, liver, fresh pork, fish, and poultry with gravy or sauce or in soups.
- Meat should be broiled, baked, stewed, roasted, or creamed.
- Meat may be ground or chopped, fish may be flaked.
- Eggs (except fried), cooked beans, casseroles with ground or shredded meat; i.e., tuna noodle casserole.
- Dairy: There is no prohibition on milk and other dairy products, but when eating cheese, select softer options such as cream cheese, brie, Neufchâtel, and ricotta. Yogurt also can be a good choice for someone with esophagitis, but avoid adding fruit, granola, or seeds.
- Milk, malted milk, or milkshakes.
- Soft cheese such as grated Parmesan or Ricotta, cheese sauces and cottage cheese.
- Vegetables: Season vegetables with butter or margarine and ground spices.
- Seasonings and Condiments: Mild mustard, soy sauce, smooth peanut butter, vinegar, catsup, salt, seasonings and spices such as lemon, pepper as tolerated, cocoa powder.
Foods to Avoid
Certain foods can irritate the esophagus or increase the risk of bleeding and should be avoided:
- Hard or Abrasive Foods: Avoid foods like taco shells, hard vegetables like carrots, raw fruits, etc., which might cause tearing of the veins.
- Highly Seasoned Foods: Highly seasoned foods, condiments not tolerated by patient, mustard seed, pickles, popcorn, olives, nuts, coconut, crunchy peanut butter, chili pepper, garlic.
- Tough Meats: Stringy, dry or fibrous-type meats (i.e. steak and spare ribs). Meats containing gristle or peppercorn. Sausage and bacon.
- Fresh or "Doughy" Breads: Fresh or "doughy" breads may cause “sticking”.
- Raw, Coarse, or Abrasive Fresh Fruits: Raw, coarse or abrasive fresh fruits.
- All Raw Vegetables, Including Salads: All raw vegetables, including salads.
Eating Habits
- Take small bites of food and chew foods well.
- Sip fluids when taking solids at meals and snacks to moisten foods.
- Stop eating when you start to feel full.
- Eat slowly in a relaxed atmosphere.
- Choose decaffeinated coffee, tea, or caffeine-free soft drinks.
- Sit upright when eating. Remain in a sitting position for at least 45-60 minutes after eating.
- Try to avoid eating for 3 hours before bedtime.
- Eat small, frequent meals and snacks.
- Easily digestible foods are the best choice, as is avoiding carbonated drinks or beverages that are very hot or very cold.
- Food that helps in digestion, such as insoluble fibers, should be consumed in order to reduce the risk of constipation.
- It is recommended to have five small meals a day. A highly nutrient breakfast would include oatmeal along with prune juice. Lunch could be chicken, beans, etc., and in the mid-afternoon, a glass of milk along with salt crackers.
Medical Treatments and Procedures
In addition to dietary changes, several medical treatments and procedures may be necessary to manage esophageal varices:
- Medications: Medicines may be prescribed to decrease pressure in the liver or reduce stomach acid. Prescription beta blockers may be effective in preventing esophageal bleeding.
- Variceal Banding: This involves placing elastic bands around the bleeding esophageal veins to cut off blood flow.
- Transjugular Intrahepatic Portosystemic Shunt (TIPS): A shunt is placed between the portal vein and the hepatic vein to reduce pressure in the portal vein.
- Liver Transplant: This is an option for people with severe liver disease or recurrent bleeding of esophageal varices.
Prevention Strategies
While there is no guaranteed way to prevent esophageal varices, especially in individuals with cirrhosis, several strategies can help reduce the risk:
- Avoid Alcohol: People with liver disease are often advised to stop drinking alcohol.
- Eat a Healthy Diet: A balanced diet supports liver health.
- Maintain a Healthy Weight: Obesity can worsen liver disease.
- Use Chemicals Sparingly and Carefully: Minimize exposure to toxins that can harm the liver.
- Reduce Your Risk of Hepatitis: Avoid sharing needles and practice safe sex to reduce the risk of hepatitis B and C.
Importance of Early Feeding After Variceal Ligation
Traditionally, oral feeding following variceal ligation in cirrhotics is delayed due to fear of rebleeding. However, recent studies suggest that early feeding may be beneficial. A controlled trial showed that patients who resumed a liquid diet one hour after variceal ligation and a regular solid diet after four hours had similar rebleeding rates compared to those with delayed feeding. Additionally, the early-feeding group had better protein and calorie intake and lower rates of early infections.
Read also: Walnut Keto Guide
Read also: Weight Loss with Low-FODMAP
tags: #diet #for #esophageal #varices