Gastric Varices

What are gastric varices?

Gastric varices are enlarged, swollen blood vessels in the lining of your stomach. They’re a serious condition that can cause life-threatening bleeding in your upper gastrointestinal tract. They’re less common than esophageal varices (swollen blood vessels in your esophagus) but more likely to cause severe bleeding.

You can get gastric varices when blood clots or scar tissue (cirrhosis) block blood flow to your liver. If blood can’t flow through your larger vessels, it will find its way through your smaller ones. But your smaller vessels can’t always handle the increased pressure, so they swell and become varices. Unless you correct this issue, these varices can burst.

Imagine your stomach has tiny highways for blood to flow through. Usually, these highways handle the traffic just fine. But sometimes, there’s a big roadblock on the main highway to the liver (like cirrhosis). This causes traffic jams (increased pressure) and blood starts looking for detours. Smaller roads in your stomach lining (like varices) aren’t built for heavy traffic and can bulge out.

Gastric varices types

Gastric varices either have a connection to your esophagus or they don’t.

Esophageal connection

• Type 1 gastroesophageal varices (GOV1): Type 1 gastroesophageal varices start near your esophagus and go along your stomach’s “upper side” (lesser curvature). Imagine a detour starting near the intersection with your esophagus and going down the left side of your stomach. This is the most common type.
• Type 2 gastroesophageal varices (GOV2): Type 2 gastroesophageal varices start near your esophagus and go along your stomach’s “under side” (greater curvature). This detour also starts near the esophagus but goes along the right side of your stomach.

No esophageal connection

• Type 1 isolated gastric varix (IGV1): This type is limited to the stomach and just bulges in your stomach’s rounded end (fundus).
• Type 2 isolated gastric varix (IGV2): This type bulges anywhere except the fundus in your stomach lining.

What are the symptoms of gastric varices?

Gastric varices themselves usually don’t cause any symptoms. But if they burst, they can cause serious bleeding. This can lead to a wide range of symptoms, like:

• Bright red blood in your poop.
• Dark, tarry poop.
• Dizziness.
• Fast heart rate.
• Loss of consciousness.
• Low blood pressure.
• Nausea.
• Shock.
• Vomiting blood.
• Weakness.

What is the cause of gastric varices?

The main cause of gastric varices is cirrhosis, a liver disease where scar tissue blocks blood flow through your liver. This blockage increases pressure in a vein called the portal vein, which carries blood from your intestines and spleen to your liver. When this pressure rises (portal hypertension), blood starts to back up and look for alternative routes. These smaller veins, like the ones in your stomach lining, then swell and become varices.

Other causes of portal hypertension that can lead to gastric varices include:

• Blood clot in the portal vein or splenic vein: This can block blood flow just like cirrhosis.
• Parasitic infections: Schistosomiasis, a parasitic infection found in parts of Africa, South America, the Caribbean, the Middle East and East Asia, can damage your liver and spleen, leading to portal hypertension.
• Non-cirrhotic causes: In rare cases, conditions other than cirrhosis can cause portal hypertension and gastric varices. This includes Budd-Chiari syndrome, which blocks the veins that carry blood out of your liver.

What are the complications of gastric varices?

The most serious complication of gastric varices is bleeding. These swollen blood vessels in your stomach lining are fragile and can rupture under pressure, leading to potentially life-threatening blood loss. Bleeding from gastric varices can be serious and requires immediate medical attention.

In rare cases, untreated gastric varices can also lead to:

• Iron-deficiency anemia: Slow blood loss over time can deplete your iron stores, leading to fatigue and other symptoms.
• Hepatic encephalopathy: This is a brain dysfunction caused by toxins building up in your bloodstream because your liver isn’t working as well as it should be.

How are gastric varices diagnosed?

Diagnosing gastric varices typically involves endoscopy and imaging tests. These tests may include:

• Upper endoscopy: This is the preferred method and often considered the gold standard for diagnosing gastric varices. A provider will insert a thin, flexible tube with a camera down your throat to directly view the lining of your esophagus and stomach. The provider can then see if there are any varices present and assess their size, color and location.
• Abdominal CT scan: This can provide a detailed view of your abdomen, including your liver, spleen and blood vessels. While it can’t directly see varices, it can identify signs of portal hypertension, which suggests an increased risk of varices.
• Doppler ultrasound: This test uses sound waves to assess blood flow through your portal vein and other abdominal vessels. Abnormal blood flow patterns can indicate portal hypertension.

How do you treat stomach varices?

Gastric varices treatment depends on whether the varices have burst or not.

Treatment for unruptured gastric varices

The main goal here is to prevent bleeding in the first place. Your provider may use medications, like nonselective beta-blockers. These medications help lower blood pressure in the portal vein, reducing the risk of variceal bleeding.

Your provider may also suggest endoscopic procedures. These minimally invasive procedures aim to close off or shrink the varices directly:

• Endoscopic variceal ligation (EVL): Your provider places small rubber bands around the varices using an endoscope, essentially cutting off their blood supply and causing them to shrink.
• Endoscopic cyanoacrylate injection: Your provider injects a glue-like substance into the varices to block them and prevent blood flow.

Treatment for bleeding gastric varices

This is a medical emergency and requires immediate intervention to stop the bleeding and prevent complications. Treatment may include:

• Hospitalization and blood transfusion: You’ll likely be admitted to the intensive care unit (ICU) for close monitoring and blood transfusions to replace lost blood.
• Endoscopic procedures: Similar to unruptured varices, providers often use endoscopic procedures like EVL or cyanoacrylate injection to stop the bleeding.
• Medications like vasopressin or octreotide: These medications help reduce blood flow to the varices, aiding in stopping the bleeding.
• Other procedures to manage pressure: In a balloon tamponade, your provider inserts a special balloon into your esophagus and inflates it to apply pressure directly to the bleeding varices. This is a temporary measure to manage bleeding. Another procedure is called a transjugular intrahepatic portosystemic shunt (TIPS). This procedure creates a shunt, or an alternate pathway, for blood to flow from your portal vein directly into your liver’s main vein. This new pathway allows blood to bypass the blockage and reduces pressure in your portal vein.

Can gastric varices be prevented?

Preventing gastric varices entirely can be difficult, but there are steps you can take to reduce the risk, especially if you have a condition that increases portal hypertension. Here’s what you can do:

Manage your underlying condition

If you have a condition like cirrhosis or schistosomiasis, following your healthcare provider’s treatment plan to manage the underlying disease is crucial.

Medications

Beta-blockers can be very effective in reducing the risk of bleeding from existing varices, although they may not prevent the varices themselves from forming.

Lifestyle changes

To reduce your risk of gastric varices, you can:

• Avoid alcohol: Alcohol is a major contributor to liver damage and can worsen portal hypertension.
• Eat healthy: Following a Mediterranean diet rich in fruits, vegetables and whole grains can help support your overall liver health.
• Reduce salt intake: Excessive salt intake can increase fluid buildup in your body, which can worsen portal hypertension.
• Maintain a healthy weight for you: Excess weight can put additional strain on your liver.
• Vaccination: Healthcare providers recommend vaccination against hepatitis A and B.

If you have any risk factors for gastric varices, it’s important to talk to a provider about regular screening with endoscopy to detect varices early. Early detection allows for prompt treatment and helps prevent the serious complications of bleeding.

What is the survival rate of gastric varices?

The survival rate for gastric varices depends on several factors, including:

• Whether they’ve bled: Bleeding from gastric varices is a serious complication and significantly reduces the survival rate.
• Severity of underlying liver disease: People with more advanced liver disease generally have a poorer prognosis.
• Effectiveness of treatment: Early diagnosis and successful treatment of varices can significantly improve the survival rate.

If you have concerns about gastric varices or your risk factors, talk to a provider. They can give you a more accurate picture of your individual prognosis.

When should I see my healthcare provider?

You shouldn’t wait to see your healthcare provider if you suspect you have gastric varices, especially if you’re experiencing any symptoms that could indicate bleeding. Here’s when to seek medical attention:

• If you’ve been diagnosed with a condition that increases your risk of portal hypertension, like cirrhosis or schistosomiasis: Talk to your provider if you need an endoscopy to detect varices early.
• If you experience any signs of bleeding from your upper gastrointestinal tract: This includes vomiting blood, rectal bleeding or dark, tarry poop.
• If you have unexplained abdominal pain or swelling: This could be a sign of ascites, fluid buildup in your abdomen, which can be associated with portal hypertension.
• If you have symptoms of portal hypertension encephalopathy: This includes confusion, drowsiness, difficulty concentrating and even coma.

Early detection and treatment of gastric varices are crucial to prevent serious complications like bleeding. If you have any concerns or risk factors, don’t hesitate to talk to your provider. They can assess your situation and recommend the most appropriate course of action.

When should I go to the ER?

If you have signs of burst gastric varices, head to the nearest emergency room immediately. Bleeding from gastric varices can be serious and requires immediate medical attention.

What questions should I ask my healthcare provider?

Questions you may want to ask your healthcare provider include:

• What caused my gastric varices?
• What are the treatment options for my gastric varices?
• What are the potential risks and side effects of treatment?
• What can I do to prevent my varices from bleeding?
• What lifestyle changes can I make to improve my liver health?
• How often will I need to be monitored for varices?
• What is the long-term outlook for someone with gastric varices?