I’m helping a client who had an emergency situation while he was traveling last year. He had esophageal variceal bleeding and was in the hospital for a few days, looking for the cause of it and couldn’t find any liver problems. All his tests are normal, just seeing conventional doctors and doing conventional tests. We’ve been working on diet and lifestyle changes. Do you have any idea about supplements and tests that could be helpful in this case?

Dr. Amy Nett:  That’s really tricky. Esophageal varices are incredibly serious. I’m not sure what testing he’s been doing, and you probably do have to do imaging studies as well. I don’t know if you’re just doing blood tests. To me, management of esophageal varices, that absolutely is a reasonable place for conventional medicine physicians to come in. Of course, lowering inflammation as best you can is a good approach, but the other thing you need to think about is whether there be something like a blood clot in the portal vein. That could be something that you might only find on imaging, so hopefully he’s had contrast-enhanced CT or MRI. I would definitely think about a blood clot in the portal vein, something like Budd-Chiari syndrome. Think about parasitic infections. I’m sure you’ve done testing for that, but schistosomiasis I would think about.

Cirrhosis, of course … when you’re saying you’ve done liver testing, I don’t know if that includes, again, probably imaging and/or biopsy. Primary biliary cirrhosis is something to think about. If all the liver markers are completely normal, that’s less likely, so I would say something like Budd-Chiari syndrome. It’s something rare, but it does absolutely need to be ruled out, so make sure he’s has adequate imaging, and then it’s just going to be being supportive as best you can to lower inflammation, but the high priority is figuring out what has caused the esophageal varices. Make sure he gets imaging.