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.
Increased pressure in the veins that deliver blood to the liver (known as
) leads to the formation of esophageal varices. The increased pressure causes blood to back up into other smaller vessels, including those of the esophagus.
The medical conditions that lead to the development of portal hypertension and esophageal varices include:
Esophageal varices are sometimes only diagnosed when it bleeds—a consequence in roughly half of all people with the condition. Though bleeding from esophageal varices may not be severe and may stop on its own, first-time bleeding events result in death in 30%-50% of cases. Bleeding esophageal varices recur in approximately half of all patients.
Signs of bleeding from esophageal varices include:
Vomiting or coughing up blood
Red, tarry, or very dark stools
Low blood pressure
If you experience any of these symptoms, do not assume it is due to esophageal varices. These symptoms may be caused by other health conditions. If you experience any one of them, see your physician.
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Your doctor may also refer you to a gastroenterologist, a specialist skilled in the treatment of diseases of the digestive system.
Tests may include the following:
Blood tests—complete blood count, liver and kidney function, and coagulation tests
—useful imaging modality to study blood flow in the portal system
Endoscopy—a small, flexible tube attached to a light and camera is inserted into the mouth down into the esophagus and stomach to view the source of any bleeding and swollen vessel
An endoscope allows the doctor to view inside organs.
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 to increase blood flow through the portal vein and relieve blood pressure in the esophageal varices.
This procedure can control bleeding in over 90% of cases.
Distal Splenorenal Shunt (DSRS)
A surgical procedure connecting the main vein in the spleen to the left kidney vein. The procedure is done to lower blood pressure in the swollen vessels and limit bleeding.
This procedure is reserved for those patients who fail to respond to either drug or endoscopic treatment and are not considered good candidates for a shunting procedure.
Liver transplantation is the only way to completely cure esophageal varices.
If you are diagnosed with esophageal varices, follow your doctor's
To help reduce your chances of getting esophageal varices, take the following steps:
Seek immediate treatment for long-term alcohol abuse.
Drugs such as beta-blockers (propranolol or nadolol) or isosorbide mononitrate could prevent recurrent bleeding.
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.
Lubel JS, Angus PW. Modern management of portal hypertension.
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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.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a