Unravelling the Downhill Spiral: A Tale of Alcohol, Varices, and a Hidden Stenosis

Downhill esophageal varices (EVs) were first described in 1964 by Felson and Lessure. They are rare with an incidence rate of 0.5 % in the general population. They usually develop due to an increase in pressure and/or obstruction of the superior vena cava (SVC) and rarely present with hematemesis. SVC syndrome, surgical ligation of the SVC, Castleman syndrome, pulmonary hypertension, and hypercontractile esophageal motility disorders can cause this. We report a case of downhill EVs in an older male with alcohol use disorder with incidental finding of SVC stenosis secondary to an old, unused chemotherapy port.