title: Downhill varices: an uncommon cause of upper gastrointestinal bleeding.
abstract: BACKGROUND
  Upper gastrointestinal bleeding (UGIB) is a common condition in gastroenterology, but "Downhill Varices" (DHV) or varices of the upper oesophagus are an uncommon cause of UGIB, with different aetiology from lower third oesophageal varices and different therapeutic implications.
  
  
  METHODS
  A 28-year-old male patient, with a history of chronic kidney failure secondary undergoing haemodialysis and superior vena cava syndrome (SCVS) due to multiple catheter replacements, was admitted to the Emergency Department with haematemesis secondary to a varicose vein rupture in the proximal third of oesophagus, treated initially with ethanolamine. Subsequent diagnostic studies showed the collateral circulation secondary to the SCVS. No further endoscopic or endovascular therapy could be performed and the patient will finally undergo a surgical bypass.
  
  
  CONCLUSIONS
  DHVs are a very uncommon condition and endoscopic band ligation emerges as the appropriate therapeutic approach for the bleeding event. The definitive therapy continues to be that for the cause of the SVCS.
authors.affiliation: Aparato Digestivo, Hospital Universitario Virgen del Rocío, España.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ontanilla Clavijo
authors.affiliation: Aparato Digestivo, 955012258, España.
authors.forename: Claudio
authors.initials: C
authors.lastname: Trigo Salado
authors.affiliation: Hospital Universitario Sant Joan de Reus.
authors.forename: Norberto
authors.initials: N
authors.lastname: Rojas Mercedes
authors.affiliation: Hospital Universitario Virgen del Rocío.
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Caballero Gómez
authors.affiliation: Hospital Universitario Virgen del Rocío.
authors.forename: Adalberto
authors.initials: A
authors.lastname: Rincón Gatica
authors.affiliation: Hospital Universitario Virgen del Rocío.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Alcívar-Vasquez
authors.affiliation: aparato Digestivo, hospital Virgen del Rocio (Sevilla), España.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Márquez Galán