TY  - JOUR
T1  - Downhill esophageal varices: a systematic review of the case reports
AU  - Ali, Hassam
AU  - Pamarthy, Rahul
AU  - Bolick, Nicole Leigh
AU  - Ali, Eslam
AU  - Paleti, Swathi
AU  - Kapuria, Devika
Y1  - 2022///
JO  - Exploration of Medicine
VL  - 3
IS  - 4
SP  - 317
EP  - 330
DO  - 10.37349/emed.2022.00096
UR  - https://www.explorationpub.com/Journals/em/Article/100196
AB  - 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.
ER  -