ReviewAnnals of medicine2025
An overview of downhill esophageal varices: a challenge for medical practice.
Review in Annals of medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed.
- Article
- Downhill Esophageal Variceal Rupture Caused by Superior Vena Cava Syndrome in NUT Carcinoma: A Case Report.Cureus · 2026Article
- Downhill Esophageal Variceal Hemorrhage Secondary to Superior Vena Cava Obstruction in a Patient With End-Stage Renal Disease: A Rare and Under-Recognized Complication.ACG case reports journal · 2026Article
- Article
- Atypical Presentation of Downhill Esophageal Varices: A Diagnostic Enigma.ACG case reports journal · 2026Article
- Hiatal Hernia-Related Esophageal Varices Misdiagnosed as Cancer: Salvaged With Clipping.ACG case reports journal · 2025Article
- Unravelling the Downhill Spiral: A Tale of Alcohol, Varices, and a Hidden Stenosis.Journal of community hospital internal medicine perspectives · 2025Article
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesUnlike the commonly seen uphill esophageal varices in clinical practice, downhill esophageal varices are caused by obstruction of the superior vena cava and azygous venous system. The predominant causes of downhill esophageal varices are hemodialysis in end-stage renal disease patients and mediastinal malignancies. The cornerstone of the treatment for downhill esophageal varices is to address the underlying primary causes. Without this, patients may suffer from recurrent bleeding, and the bleeding can be fatal.
methodsThis review is primarily summarized through previous case reports. Meanwhile, it emphasizes the significance of case reports.
resultsClinicians should be conscious that esophageal varices are not necessarily caused by liver cirrhosis or non-cirrhotic portal hypertension.
conclusionsSpecifically, when varices are only observed in the upper and middle esophagus, and the patient presents with evidence of superior vena cava obstruction, clinicians should be particularly vigilant for downhill esophageal varices. Moreover, a thorough investigation and definitive treatment of the underlying primary causes should be implemented.
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Registered trials
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