"Downhill" Esophageal Varices Due to Dialysis Catheter-Induced Superior Vena Caval Occlusion: A Rare Cause of Upper Gastrointestinal Bleeding

Overview

Journal Case Rep Gastrointest Med

Publisher Wiley

Specialty Gastroenterology

Date 2013 Mar 20

PMID 23509642

Citations 5

Authors

Suresh Kumar Nayudu

Anil Dev

Kalyan Kanneganti

Affiliations

Soon will be listed here.

Abstract

"Downhill" varices are a rare cause of acute upper gastrointestinal bleeding. Rarely these varices are reported in patients receiving hemodialysis as a complication of chronic dialysis vascular access. We present a case of acute upper gastrointestinal bleeding in an individual with end-stage renal disease receiving hemodialysis. Esophagogastroduodenoscopy revealed "downhill" varices in the upper third of the esophagus without any active bleeding at the time of the procedure. An angiogram was performed disclosing superior vena caval occlusion, which was treated with balloon angioplasty. Gastroenterologists should have a high index of suspicion for these rare "downhill" varices when dealing with acute upper gastrointestinal bleeding in patients receiving hemodialysis and manage it appropriately using endoscopic, radiological, and surgical interventions.

Citing Articles

An overview of downhill esophageal varices: a challenge for medical practice.

Wang D, Ma Z Ann Med. 2025; 57(1):2462452.

PMID: 39903475 PMC: 11795747. DOI: 10.1080/07853890.2025.2462452.

Uphill or downhill bleeding?.

Cargill Z, Cargill T, Lei B, Bekkali N, East J, Marshall J Gut. 2020; 70(12):2282-2348.

PMID: 32826306 PMC: 8588284. DOI: 10.1136/gutjnl-2020-322298.

Downhill esophageal varices: a therapeutic dilemma.

Chakinala R, Kumar A, Barsa J, Mehta D, Haq K, Solanki S Ann Transl Med. 2019; 6(23):463.

PMID: 30603651 PMC: 6312812. DOI: 10.21037/atm.2018.11.13.

Downhill esophageal varices: unusual cause of hematemesis.

Raghavapuram S, George N, Girotra M, Siddique S, Tharian B VideoGIE. 2018; 2(9):231-232.

PMID: 29905318 PMC: 5991938. DOI: 10.1016/j.vgie.2017.02.005.

Bleeding 'downhill' esophageal varices associated with benign superior vena cava obstruction: case report and literature review.

Loudin M, Anderson S, Schlansky B BMC Gastroenterol. 2016; 16(1):134.

PMID: 27776486 PMC: 5078907. DOI: 10.1186/s12876-016-0548-7.

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