Esophageal Varices



Esophageal varices can happen when blood flow to the liver is blocked. The blockage is often due to scarring from liver disease. Pressure builds in the large vein that brings blood to the liver. This is called portal hypertension. The pressure causes blood to flow into other smaller blood vessels, such as those found in the esophagus. This leads to varices.

This may be caused by:

  • Blood clots of the splenic, portal, or hepatic veins
  • Certain infections
  • Abnormal connections between the arteries and veins in the liver or spleen
  • Cirrhosis of the liver
  • Severe heart failure
  • Hodgkin lymphoma
  • Sarcoidosis

Risk Factors

Things that raise the risk of esophageal varices are:

  • Alcohol use disorder
  • Obesity
  • Having other conditions linked to liver disease, such as ascites or liver cancer



Some people have no symptoms. If esophageal varices bleed, the signs may be:

  • Vomiting or coughing up blood that may look like coffee grounds
  • Red, tarry, or very dark stools (poop)
  • Light-headedness
  • Fast heartbeat

The amount of bleeding can vary. It may stop on its own or be more serious. Without fast treatment, severe bleeding can be fatal.


The doctor will ask about symptoms and past health. A physical exam may be done.

The doctor can look at the esophagus with:

  • An upper GI endoscopy
  • Ultrasound
  • CT scan



The goal is to prevent or stop varices from bleeding. Serious bleeding needs to be stopped as soon as possible. Options are:

  • Medicines to lower blood pressure or cholesterol, which helps:
  • Lower the risk of bleeding, or
  • Slow any bleeding that is happening
  • Procedures such as:
  • Endoscopic band ligation—to tie a band around the varices to prevent or stop bleeding
  • Balloon tamponade to pass a balloon through the nose—to compress bleeding varices
  • Transjugular intrahepatic portosystemic shunting—to connect the portal vein to the hepatic vein using a stent to control bleeding
  • Distal splenorenal shunt—to limit bleeding by connecting the main vein in the spleen to the vein in the left kidney

A liver transplant is the only way to completely cure esophageal varices.


There are no known guidelines to lower the risk of esophageal varices.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.