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Esophageal Varices
Pronounced: ee-sof-uh-jeel var-i-seez
Definition
The esophagus is a tube that goes from the mouth to the stomach. Esophageal varices are abnormally swollen veins. They are found in the lining of the esophagus. If they're not found or are left untreated, rupture and cause life threatening bleeding.
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Causes
When pressure builds in the veins that bring blood to the liver, it's called portal hypertension. The pressure causes blood to backup into other smaller blood vessels. This includes those found in the esophagus. This leads to varices.
The main causes of these conditions are:
- Cirrhosis of the liver
- Blood clots of the splenic, portal, or hepatic veins
- Abnormal connections between the arteries and veins in the liver or spleen
- Certain infections
- Severe heart failure
- Hodgkin lymphoma
- Sarcoidosis
Risk Factors
Your chances of esophageal varices are higher for:
- Alcohol use disorder
- Obesity
- Having other conditions linked to liver disease such as ascites or liver cancer
Symptoms
You may not notice problems until bleeding starts. Bleeding may not be serious and stop on its own. Signs of bleeding:
- Vomiting or coughing up blood—may look like coffee grounds
- Red, tarry, or very dark stools
- Lightheadedness from low blood pressure
- Rapid heartbeat
If you notice bleeding, seek care right away. Even bleeding the first time can result in death for some people.
Diagnosis
Your doctor will ask about your symptoms and health history.
You may have:
- A physical exam
- Blood tests
- An upper GI endoscopy —a scope is used to look at the structures from the back of the throat to the small intestine
- Ultrasound
- CT scan
Treatment
The goal is to prevent varices from bleeding. This can be done with:
Medicines
Medicines will lower blood pressure or cholesterol. These will help lower the risk of bleeding or slow any bleeding that is happening.
Endoscopic Band Ligation
Varices can be tied off during an endoscopic band ligation. A rubber band is used to prevent ruptures or stop bleeding.
Balloon Tamponade
A balloon is passed through the nose to the varices. It's used to compress the ones that are bleeding.
Transjugular Intrahepatic Portosystemic Shunting (TIPS)
TIPS involves threading a small tube from the neck to the liver. The tube helps to place a stent. A stent will help blood flow through the portal vein better by holding it open. This will ease pressure in the esophageal veins. It can control bleeding in most cases.
Distal Splenorenal Shunt (DSRS)
DSRS connects the main vein in the spleen to the vein in the left kidney. It lowers blood pressure in the swollen vessels and limits bleeding.
Liver Transplant
A liver transplant is the only way to completely cure esophageal varices.
Prevention
To help lower your chances of esophageal varices:
- Seek prompt care if you have any conditions that can cause it.
- If you're at high risk, your doctor may give you medicines.
RESOURCES:
American Society for Gastrointestinal Endoscopy
https://www.asge.org
National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov
CANADIAN RESOURCES:
Canadian Association of Gastroenterology
https://www.cag-acg.org
Canadian Liver Foundation
https://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(2):171-177.
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 Opin Pharmacother. 2004;5(2):349-360.
Esophageal varices. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T113964/Esophageal-varices. Updated November 12, 2014. Accessed August 14, 2018.
Esophageal varices—prevention of rebleeding. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T483095/Esophageal-variceal-hemorrhage-prevention-of-rebleeding. Updated May 25, 2017. Accessed August 14, 2018.
Esophageal varices—primary prophylaxis. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T113964/Esophageal-varices. Updated May 25, 2017. Accessed August 14, 2018.
Garcia-Tsao G, Sanyal AJ. Prevention and management of gastroesophageal varicies and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007;102(9):2086-2102.
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):45-49.
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(4):560-567.
Last reviewed May 2018 by EBSCO Medical Review Board Daus Mahnke, MD Last Updated: 8/14/2018