Esophageal Varices

What are esophageal varices?

Varices are veins that are enlarged or swollen. The esophagus is the tube that connects the throat to the stomach. When enlarged veins occur on the lining of the esophagus, they are called esophageal varices.

Who is at risk for esophageal varices that break open and bleed?

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.

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 liver conditions can lead to esophageal varices?

Any type of serious liver disease can cause esophageal varices. Cirrhosis is the most common type of liver disease, and more than 90% of these patients will develop esophageal varices sometime in their lifetime; about 30% will bleed. In cirrhosis, large sections of scar tissue develop throughout the liver and cause blood flow to slow. Cirrhosis can be caused by alcoholic liver disease, fatty liver disease, viral hepatitis or other diseases of the liver.

Thrombosis (blood clot) in the portal vein or the splenic vein, which connects to the portal vein, can cause esophageal varices.

Two rare conditions that can cause esophageal varices are Budd-Chiari syndrome (blockage of certain veins in the liver) and infection with the parasite schistosomiasis.

What are the symptoms of esophageal varices?

Most people do not know they have esophageal varices until the varices start to bleed. When bleeding is sudden and severe, the person vomits large amounts of blood. When bleeding is less severe, the person may swallow it, causing black, tarry stools. If bleeding is uncontrolled, signs of shock may develop, including pale, clammy skin, irregular breathing and loss of consciousness.

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