Active bleeding from downhill varices: case report and management

Abstract

Proximal esophageal varices, or downhill varices, develop in the setting of venous hypertension of the superior systemic circulation, commonly because of superior vena cava (SVC) obstruction. They are named based on their cephalad-to-caudal direction of blood flow. The incidence of downhill varices is low (0.5%), and they account for 0.4% to 10% of all acute esophageal variceal bleeding.