What causes esophageal varices?

Esophageal varices are primarily caused by increased pressure in the portal venous system, a condition known as portal hypertension. This is commonly seen in individuals with liver disease, particularly alcoholic liver disease, where the liver becomes damaged and scarred. The damage obstructs blood flow through the liver, leading to increased pressure in the portal vein. As the pressure builds, blood seeks alternative pathways to return to the heart, resulting in the development of varices, or swollen veins, in the esophagus.

In this context, hypertension related to liver dysfunction, especially due to chronic conditions like cirrhosis or severe alcoholic liver disease, is a significant risk factor for esophageal varices. Thus, understanding the role of portal hypertension in liver health is critical for recognizing the formation of these varices and the potential life-threatening complications they can cause, such as bleeding.

The other options do not lead to the formation of esophageal varices in the same way that portal hypertension does, as they are not directly related to the underlying vascular changes associated with liver disease.