What are esophageal varices?
Esophageal varices are abnormal, enlarged veins in the tube that connects the throat and stomach (esophagus). This condition occurs most often in people with serious liver diseases.
Esophageal varices develop when normal blood flow to the liver is blocked by a clot or scar tissue in the liver. To go around the blockages, blood flows into smaller blood vessels that aren’t designed to carry large volumes of blood. The vessels can leak blood or even rupture, causing life-threatening bleeding.
A number of drugs and medical procedures can help prevent and stop bleeding from esophageal varices
How common are esophageal varices?
Please discuss with your doctor for further information.
What are the symptoms of esophageal varices?
Esophageal varices usually don’t cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices include:
- Vomiting and seeing significant amounts of blood in your vomit
- Black, tarry or bloody stools
- Loss of consciousness (in severe case)
Your doctor might suspect varices if you have signs of liver disease, including:
- Yellow coloration of your skin and eyes (jaundice)
- Easy bleeding or bruising
- Fluid buildup in your abdomen (ascites)
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes esophageal varices?
The liver is the organ that cleanses toxins from the blood. The portal vein delivers blood to the liver. Esophageal varices usually occur in people with liver disease. Blood flow through the liver slows when liver disease is present. When this happens, the pressure in the portal vein goes up.
High blood pressure in the portal vein (portal hypertension) pushes blood into surrounding blood vessels, including vessels in the esophagus. These blood vessels have thin walls and are close to the surface. The extra blood causes them to expand and swell. Varices also can develop in the small blood vessels in the upper stomach.
If the pressure caused by the extra blood gets too high, varices can break open and bleed. Bleeding is an emergency that requires urgent treatment. Uncontrolled bleeding can quickly lead to shock and death.
What increases my risk for esophageal varices?
Not everyone who develops esophageal varices will have bleeding. Factors that increase the risk for bleeding include:
- High portal blood pressure. The higher the portal pressure, the greater the risk of bleeding.
- Large varices. Risk of bleeding increases with size of varices.
- Severe liver disease. Advanced cirrhosis or liver failure increases the risk.
- Ongoing alcohol consumption. In patients with varices due to alcohol, continuing to drink increases the risk of bleeding.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How are esophageal varices diagnosed?
If you have cirrhosis, your doctor should screen you for esophageal varices when you’re diagnosed. How often you’ll undergo screening tests depends on your condition. Main tests used to diagnose esophageal varices are:
- Endoscope exam. A procedure called upper gastrointestinal endoscopy is the preferred method of screening for varices. Your doctor inserts a thin, flexible, lighted tube (endoscope) through your mouth and into your esophagus, stomach and the beginning of your small intestine (duodenum). The doctor will look for dilated veins, measure them, if found, and check for red streaks and red spots, which usually indicate a significant risk of bleeding. Treatment can be performed during the exam.
- Imaging tests. Both abdominal CT scans and Doppler ultrasounds of the splenic and portal veins can suggest the presence of esophageal varices.
- Capsule endoscopy. In this test, you swallow a vitamin-sized capsule containing a tiny camera, which takes pictures of the esophagus as it goes through your digestive tract. This might be an option for people who are unable or unwilling to have an endoscope exam. This technology is more expensive than regular endoscopy and not as available.
How are esophageal varices treated?
The primary aim in treating esophageal varices is to prevent bleeding. Bleeding esophageal varices are life-threatening. If bleeding occurs, treatments are available to try to stop the bleeding.
Treatment to prevent bleeding
Treatments to lower blood pressure in the portal vein may reduce the risk of bleeding esophageal varices. Treatments may include:
- Medications to reduce pressure in the portal vein. A type of blood pressure drug called a beta blocker may help reduce blood pressure in your portal vein, decreasing the likelihood of bleeding. These medications include propranolol (Inderal, Innopran) and nadolol (Corgard).
- Using elastic bands to tie off bleeding veins. If your esophageal varices appear to have a high risk of bleeding, your doctor might recommend a procedure called band ligation.
Using an endoscope, the doctor snares the varices and wraps them with an elastic band, which essentially “strangles” the veins so they can’t bleed. Esophageal band ligation carries a small risk of complications, such as scarring of the esophagus.
Treatment if you’re bleeding
Bleeding varices are life-threatening, and immediate treatment is essential. Treatments used to stop bleeding and reverse the effects of blood loss include:
- Using elastic bands to tie off bleeding veins.
- Medications to slow blood flow into the portal vein. A drug called octreotide (Sandostatin) is often used with endoscopic therapy to slow the flow of blood from internal organs to the portal vein. The drug is usually continued for five days after a bleeding episode.
- Diverting blood flow away from the portal vein. Your doctor might recommend a procedure called transjugular intrahepatic portosystemic shunt (TIPS) to place a shunt. The shunt is a small tube that is placed between the portal vein and the hepatic vein, which carries blood from your liver to your heart. The shunt reduces pressure in the portal vein and often stops bleeding from esophageal varices. But TIPS can cause serious complications, including liver failure and mental confusion, which can develop when toxins that the liver normally would filter are passed through the shunt directly into the bloodstream. TIPS is mainly used when all other treatments have failed or as a temporary measure in people awaiting a liver transplant.
- Restoring blood volume. You might be given a transfusion to replace lost blood and clotting factor to stop bleeding.
- Preventing infection. There is an increased risk of infection with bleeding, so you’ll likely be given an antibiotic to prevent infection.
- Replacing the diseased liver with a healthy one. Liver transplant is an option for people with severe liver disease or those who experience recurrent bleeding of esophageal varices. Although liver transplantation is often successful, the number of people awaiting transplants far outnumbers the available organs.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage esophageal varices?
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Esophageal varices. https://my.clevelandclinic.org/health/articles/esophageal-varices. Accessed November 7, 2017
Esophageal varices. https://www.mayoclinic.org/diseases-conditions/esophageal-varices/diagnosis-treatment/drc-20351544. Accessed November 7, 2017
Review Date: November 7, 2017 | Last Modified: November 9, 2017