Esophageal Varices

Pronounced: ee-sof-uh-jeel var-i-seez

Definition    TOP

The esophagus connects the mouth to the stomach. Esophageal varices are abnormally swollen veins within the lining of the esophagus. If undiagnosed or untreated, esophageal varices can rupture and lead to life-threatening bleeding.

The Esophagus

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Causes    TOP

Increased pressure in the veins that deliver blood to the liver is known as portal hypertension. The increased pressure causes blood to back up into other smaller vessels, including those of the esophagus. This leads to the formation of esophageal varices.

The medical conditions that lead to the development of portal hypertension and esophageal varices include:

  • Cirrhosis of the liver
  • Blood clots of the splenic, portal, or hepatic veins
  • Arterial-portal venous fistula—abnormal connections between arteries and veins in the liver or spleen
  • Certain infections, such as schistosomiasis, which is a parasite
  • Severe heart failure
  • Hodgkin's disease
  • Sarcoidosis

Risk Factors    TOP

Factors that increase your chance of developing esophageal varices include:

  • Chronic alcohol intake
  • Chronic viral hepatitis

Symptoms    TOP

Esophageal varices are usually only diagnosed when bleeding occurs. Though bleeding from esophageal varices may not be severe and may stop on its own, first-time bleeding events may result in death in some cases.

Signs of bleeding from esophageal varices include:

  • Vomiting or coughing up blood
  • Red, tarry, or very dark stools
  • Low blood pressure
  • Lightheadedness
  • Rapid heartbeat

Diagnosis    TOP

Your doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include the following:

  • Endoscopy to view your esophagus
  • Ultrasound
  • Blood tests

Treatment    TOP

Several treatments can help lower the risk of vessel rupture or stop bleeding if it starts. Treatment options include the following:

Drug Therapy

Drugs may be given to lower blood pressure in the veins to decrease the risk of bleeding or help slow bleeding.

Endoscopic Band Ligation

During endoscopic band ligation, a rubber band is tied around bulging veins to prevent ruptures or stop bleeding.

Balloon Tamponade    TOP

This procedure involves the passage of a balloon through the nose to help compress the bleeding varices.

Sclerotherapy    TOP

During sclerotherapy, drugs intended to slow bleeding are injected into the bleeding vein and sometimes into the surrounding area. The drugs cause clots to form and harden the vein to stop bleeding.

Transjugular Intrahepatic Portosystemic Shunting (TIPS)    TOP

TIPS involves threading a catheter from a neck vein to the liver. A stent, a small tube designed to keep veins open, is bound to the catheter and inserted into the liver. It will increase blood flow through the portal vein and relieve blood pressure in the esophageal varices. This procedure can control bleeding in most cases.

Distal Splenorenal Shunt (DSRS)    TOP

DSRS is a surgical procedure that connects the main vein in the spleen to the left kidney vein. The procedure is done to lower blood pressure in the swollen vessels and to limit bleeding.

Esophageal Transection    TOP

This procedure is reserved for patients who fail to respond to drug or endoscopic treatment and are not considered good candidates for a shunting procedure.

Liver Transplant    TOP

Liver transplantation is the only way to completely cure esophageal varices.

Prevention    TOP

To help reduce your chances of getting esophageal varices, take these steps:

  • Seek immediate treatment for long-term alcohol abuse.
  • Tell your doctor if you are at risk for chronic liver disease, blood clots, or are on medications that may damage the liver.

If you already have chronic liver disease, your doctor may prescribe drugs to prevent swollen vessels from developing.

RESOURCES:

American College of Gastroenterology
http://www.gi.org
American Gastroenterological Association
http://www.gastro.org

CANADIAN RESOURCES:

The Canadian Association of Gastroenterology
http://www.cag-acg.org
Canadian Liver Foundation
http://www.liver.ca

References:

Berry PA, Wendon JA. The management of severe alcoholic liver disease and variceal bleeding in the intensive care unit. Curr Opin Crit Care . 2006;12:171-7.
Bhasin DK, Siyad I. Variceal bleeding and portal hypertension: new lights on old horizon. Endoscopy . 2004;36(2):120-129.
D’Amico G. The role of vasoactive drugs in the treatment of oesophageal varices. Expert Opinion Pharmacotherapy . 2004;5(2):349-360.
Garcia-Tsao G, Sanyal AJ. Prevention and management of gastroesophageal varicies and variceal hemorrhage in cirrhosis. Am J Gastroenterol . 2007;102(9):2086-2102.
Gastroesophageal varices. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what . Updated May 13, 2013. Accessed July 10, 2013.
Kamath PS. Esophageal variceal bleeding: primary prophylaxis. Clin Gastroenterol Hepatol . 2005;3(1):90-93.
Lubel JS, Angus PW. Modern management of portal hypertension. Intern Med J . 2005;35(1):45-9.
Villanueva C, Piqueras M, Aracil C, et al. A randomized controlled trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleeding. J Hepatol .2006;45:560-7
Last reviewed June 2014 by Michael Woods, MD
Last Updated: 7/10/2013