Gastric Varices: Are They Always a Sign of Advanced Cirrhosis?

Gastric varices are commonly associated with liver cirrhosis, particularly in its middle or later stages. In patients with advanced cirrhosis, esophageal and gastric varices tend to be more pronounced due to increased pressure in the portal venous system. However, it's important to note that even individuals in the compensated stage of cirrhosis may develop these varices.

One of the hallmark features of cirrhosis is the presence of regenerative nodules and fibrosis, which appear as "pseudolobules" under pathological examination. While the presence of pseudolobules confirms a diagnosis of cirrhosis, imaging studies may not always reveal typical signs of liver cirrhosis in its early phases. During this time, there may be no visible esophageal or gastric varices present.

Cirrhosis diagnosis does not solely rely on the presence of varices but also includes specific clinical and biochemical markers. For example, a patient may be diagnosed with compensated cirrhosis if they exhibit low albumin levels (less than 35g/L), reduced platelet count (below 100×10^9/L), or decreased white blood cell levels, even in the absence of noticeable symptoms. Gastric or esophageal varices observed during endoscopic examination further support the diagnosis.

In contrast, decompensated cirrhosis—considered the end-stage of the disease—is marked by progressive liver dysfunction and complications of portal hypertension. Portal hypertension often leads to severe varices that can pose a high risk of bleeding. These complications typically signal a more advanced and life-threatening phase of liver disease.

Understanding the progression of cirrhosis and its related symptoms is crucial for early detection and management. Regular screening through endoscopy and lab tests can help identify changes before reaching the decompensated stage. Early intervention significantly improves prognosis and quality of life for patients with cirrhosis.