Upper gastrointestinal bleeding secondary to downhill varices in a patient with chronic kidney disease: a case report
DOI:
https://doi.org/10.47892/rgp.2026.463.2249Keywords:
Gastrointestinal Hemorrhage, Esophageal Varices, Venous ThrombosisAbstract
Downhill varices are an uncommon subtype of esophageal varices, generally associated with obstruction of upper venous return. Unlike varices caused by portal hypertension, there are no specific clinical guidelines describing them, so the available information is based mainly on isolated case reports and limited series. We present the case of a 31-year-old woman with chronic kidney disease (CKD), on hemodialysis for 17 years, and with a history of multiple central venous access devices. The patient was admitted to the emergency department with hematemesis and melena. Endoscopic examination identified downhill varices. After treatment with endoscopic ligation and polidocanol, subsequent studies revealed a central venous obstruction causing this condition. This case highlights the importance of considering this entity in patients with similar risk factors, as well as the need to generate more evidence to contribute to the development of specific recommendations for its diagnosis and appropriate management.
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Copyright (c) 2026 Gonzalo David Layza-Reyes, Elizabeth Omayra Lara-Romo, Andrea Angibette Laureano-Colca, Eloy Maier Valencia Reyes, Alvaro Bellido-Caparó
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