What is the treatment for esophageal varices?
The goals of treatment are to:
- Prevent more liver damage.
- Prevent varices from bleeding.
- Control bleeding if it occurs.
Preventing Liver Damage
People with liver disease need to avoid toxins that cause additional stress on the liver and more damage to it. Some suggestions for maintaining a healthier liver include:
- Avoid alcoholic beverages of any kind.
- Limit use of household cleaners and chemicals.
- Eat a healthier diet that is low in fat and high in fruits and vegetables, whole grains, and lean proteins.
- Maintain a healthy body weight (excess body fat puts stress on the liver)
Medications to reduce blood pressure in the portal vein can reduce the risk of bleeding. The most commonly used are a group of drugs called beta blockers. These include propranolol (Inderal®), nadolol (Corgard®) and carvedilol (Coreg®). Isosorbide mononitrate (Imdur®, Ismo®, Monoket®) is another type of medication – a nitrate – that is used to reduce portal vein pressure.
Patients with a high risk of bleeding may undergo preventive treatment with the same techniques that are used to stop bleeding. The most commonly used technique is variceal ligation.
Bleeding from esophageal varices is an emergency that requires immediate treatment. In the hospital, patients receive large amounts of fluid and blood to replace what has been lost.
Two different treatments are available to stop variceal bleeding. Both of these treatments are non-surgical procedures: 1.) variceal ligation performed through an endoscope, and 2.) transjugular intrahepatic portosystemic shunt (TIPS) done by a radiologist using x-ray.
Variceal ligation. In variceal ligation, tiny elastic bands are wrapped around the varices. This cuts off blood flow through the varices. This can be performed on as many veins as necessary in one session. After the bleeding is controlled with variceal ligation, patients may be given a drug to prevent bleeding from starting again.
Complications associated with variceal ligation include blood loss, puncture of the esophagus, difficulty swallowing, abnormal heartbeat, infection, fever and reduced or shallow breathing rate. All of these complications are rare.
Transjugular intrahepatic portal-systemic shunting (TIPS). Patients who have esophageal varices that bleed due to severe cirrhosis may need to have TIPS, which is a procedure to reduce portal blood pressure.
In TIPS, a small, thin tube called a catheter is inserted into a vein in the neck. The catheter is passed through the body to the liver where the hepatic and portal veins are close. (The hepatic vein carries blood from the liver back to the heart.)
Next, a wire is passed through the catheter. It is used to poke through the hepatic vein to the portal vein. The wire is removed and a stent, a tiny wire coil, is passed through the catheter to the connection site. The stent is placed in the new channel between the portal and hepatic veins. The stent holds the connection site open so blood can flow more easily from the portal vein to the hepatic vein and exit the liver. This reduces the pressure in the portal vein, which reduces the pressure in the varices, which reduces their risk of bleeding.