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.
Not everyone who develops esophageal varices will have bleeding. Factors that increase the risk for bleeding include:
The liver is the organ that cleanses toxins (poisons) from the blood. The portal vein delivers blood to the liver. Esophageal varices usually occur in people who have liver disease. Blood flow through the liver slows in people who have liver disease. 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 part of the 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.
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.
Any type of serious liver disease can cause esophageal varices. Cirrhosis is the most common type of liver disease. More than 90% of these patients will develop esophageal varices sometime in their lifetime, and about 30% will bleed.
In patients who have 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.
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 the blood, which can cause black, tarry stools. If bleeding is not controlled, the person may develop signs of shock, including pale, clammy skin, irregular breathing and loss of consciousness.
Regular screening for esophageal varices is recommended for people who have advanced liver disease. Screening is done by endoscopy. An endoscope is a thin, flexible tube with a light and a tiny camera on the tip. The physician passes the endoscope down the esophagus, and the camera sends images of the inside of the esophagus to a monitor. The physician looks at the images to detect enlarged veins and grades them by size. Red lines on the veins are a sign of bleeding.
The physician may also use the endoscope to examine the stomach and the upper part of the small intestine. This is called an esophogastroduodenoscopy (EGD).
Imaging by CT or MRI scan is also used to diagnose esophageal varices, often in combination with endoscopy. The pictures created by CT or MRI show the esophagus, the liver and the portal and splenic veins. They give the physician more information about the liver’s health than endoscopy alone.
The goals of treatment are to:
Preventing liver damage
People who have 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:
Medications to reduce blood pressure in the portal vein can reduce the risk of bleeding. The most commonly used medications are a group called beta blockers. These include propranolol (Inderal®), nadolol (Corgard®) and carvedilol (Coreg®).
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, non-surgical treatments are available to stop variceal bleeding--variceal ligation performed through an endoscope, and transjugular intrahepatic portosystemic shunt (TIPS) done by a radiologist using x-ray.
Bleeding esophageal varices is life-threatening condition and can be fatal in up to 50% of patients. People who have had an episode of bleeding esophageal varices are at risk for bleeding again.
Treatment with variceal ligation is effective in controlling first-time bleeding episodes in about 90% of patients. However, about half of patients treated with variceal ligation will have another episode of bleeding within 1 to 2 years. Medication and lifestyle changes can help reduce the risk of recurrence (return of bleeding).
Liver transplant many be an option for patients who have severe cirrhosis and/or repeated episodes of bleeding varices. Liver transplant is only performed at selected centers around the country that meet very strict criteria.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 04/10/2019