Wang Donghong, Ma Zhibin
Department of Internal Medicine, Harbin Medical University, Harbin, Heilongjiang, China.
Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
Ann Med. 2025 Dec;57(1):2462452. doi: 10.1080/07853890.2025.2462452. Epub 2025 Feb 4.
Unlike the commonly seen uphill esophageal varices in clinical practice, downhill esophageal varices are caused by obstruction of the superior vena cava and azygous venous system. The predominant causes of downhill esophageal varices are hemodialysis in end-stage renal disease patients and mediastinal malignancies. The cornerstone of the treatment for downhill esophageal varices is to address the underlying primary causes. Without this, patients may suffer from recurrent bleeding, and the bleeding can be fatal.
This review is primarily summarized through previous case reports. Meanwhile, it emphasizes the significance of case reports.
Clinicians should be conscious that esophageal varices are not necessarily caused by liver cirrhosis or non-cirrhotic portal hypertension.
Specifically, when varices are only observed in the upper and middle esophagus, and the patient presents with evidence of superior vena cava obstruction, clinicians should be particularly vigilant for downhill esophageal varices. Moreover, a thorough investigation and definitive treatment of the underlying primary causes should be implemented.
与临床实践中常见的上行性食管静脉曲张不同，下行性食管静脉曲张是由上腔静脉和奇静脉系统阻塞引起的。下行性食管静脉曲张的主要病因是终末期肾病患者的血液透析和纵隔恶性肿瘤。治疗下行性食管静脉曲张的关键是解决潜在的原发性病因。否则，患者可能会反复出血，且出血可能是致命的。
本综述主要通过既往病例报告进行总结。同时，强调病例报告的重要性。
临床医生应意识到食管静脉曲张不一定由肝硬化或非肝硬化门静脉高压引起。
具体而言，当仅在上段和中段食管观察到静脉曲张，且患者出现上腔静脉阻塞的证据时，临床医生应特别警惕下行性食管静脉曲张。此外，应针对潜在的原发性病因进行全面调查和明确治疗。
