@article{10.37349/emed.2022.00096,
abstract = {Aim: The etiologies, presentation, and management of downhill varices in the era of modern medicine are relatively under-explored and mostly limited to case reports or case series. Methods: Published case reports/series of patients ≥ 18 years old with proven/probable downhill esophageal varices were searched on Ovid MEDLINE and Ovid EMBASE for all published cases up to January 2021. Results: The mean age was 50.9 (standard deviation ± 17.6) years old for all downhill variceal cases. End-stage renal disease was the most common comorbidity (43.9%), followed by thyroid disease (12.2%), Behçet's disease (9.8%), and pulmonary hypertension (7.3%). Dialysis catheters, central venous grafts, or additional catheters were additional risk factors (51.2%). Variceal bleeding presenting as hematemesis, melena, or both was the most common presenting symptom (80.5%). Conclusions: Dialysis catheter-associated superior vena cava obstruction resulted in an increased risk of downhill varices. Other causes include thyroid malignancies, pulmonary hypertension, and Behçet's disease.},
author = {Ali, Hassam and Pamarthy, Rahul and Bolick, Nicole Leigh and Ali, Eslam and Paleti, Swathi and Kapuria, Devika},
doi = {10.37349/emed.2022.00096},
journal = {Exploration of Medicine},
pages = {317--330},
title = {{Downhill esophageal varices: a systematic review of the case reports}},
url = {https://www.explorationpub.com/Journals/em/Article/100196},
volume = {3},
year = {2022},
number = {4}
}