(e) Alginte-antacid (Gaviscon) can be chewed one hour after each
meal and at bedtime in the dose of one or two tablets chewed thoroughly to relieve the
(f) Bland meals are recommended: milk, cream, prepared cereals,
gelatin, soup, rice, butter, crackers, eggs, lean meat, fish, and cottage cheese.
(g) Eat slowly.
(h) Do not eat anything three or four hours before going to bed.
(i) Avoid esophageal irritants such as alcohol, tobacco, coffee,
chocolate, carbonated beverages, mints, chewing gum, and sucking on hard candies.
c. Esophageal Varices.
(1) Definition. Esophageal varices means enlarged and twisted veins in the
esophagus, usually in the lower part of the esophagus. This esophageal vein condition
may extend even into the stomach and into the upper esophagus.
(2) Etiology. There are several causes of esophageal varices, but the most
common cause is portal hypertension which is abnormally increased blood pressure in
the portal venous system. When blood cannot flow through the portal vein freely, the
blood tries another route--bypassing the portal vein and liver and reaching the venae
cavae through various other veins. The blood is forced through the coronary veins of
the stomach, the network of veins surrounding the cardia, and the lower esophageal
veins. This causes unusual pressure on the esophageal veins, and the result is that the
veins stretch and twist becoming esophageal varices. Another cause of esophageal
varices is abnormal blood circulation in the splenic vein the superior vena cava.
(3) Signs/symptoms. There are usually no symptoms until the mucosa over
the veins becomes ulcerated. When that happens, massive hemorrhaging takes place.
(4) Rupture. Several factors contribute to rupture of esophageal veins.
Muscular strain from coughing and vomiting is one factor. Another is esophagitis
(inflammation of the esophagus). Poorly chewed foods can irritate esophagal veins. An
individual with a history of alcoholism is very liable to have esophageal varices that
(a) Signs/symptoms. Rupture of the enlarged, twisted veins is
painless. Abruptly, hematemesis (vomiting of blood) occurs. Melena, passage of dark,
tarry stools due to blood which has originated in the intestinal tract, may occur. Loss of
blood may cause shock with these signs and symptoms: pale, clammy skin;
progressive, consistent fall in blood pressure; rapid, thready, or quivery pulse; rapid and
shallow respirations; and blueness of fingernail beds or lips due to lack of oxygen.