Downhill esophageal varix

Downhill esophageal varices are an uncommon type of esophageal varices associated with superior vena cava (SVC) obstruction.


Downhill oesophagal varices are less frequently seen. It is seen in less than 0.5% of routine upper endoscopies. Most common etiology is superior vena obstruction of any cause. It is seen in almost 30% of the cases of SVC obstruction .

Clinical presentation

The underlying cause for SVC obstruction and symptoms related to that. It bleeds less often than more common uphill esophageal varices which is seen in portal hypertension. There is no associated cirrhosis or portal hypertension of any cause.

Treatment and prognosis

Treating the underlying cause of SVC obstruction.

History and etymology

The first description of the downhill esophageal varices located in the upper third of the esophagus without the existence of portal hypertension was in 1964 by Felson and Lessure .

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