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
- Severe heart failure
- Hodgkin lymphoma
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
- Rapid heartbeat
Several treatments can help lower the risk of vessel rupture or stop bleeding if it starts. Treatment options include the following:
Medications 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.
This procedure involves the passage of a balloon through the nose to help compress the bleeding varices.
Transjugular Intrahepatic Portosystemic Shunting (TIPS)
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)
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.
This procedure is reserved for those who fail to respond to medications or endoscopic treatment and are not considered good candidates for a shunting procedure.
Liver transplantation is the only way to completely cure esophageal varices.
To help reduce your chance of esophageal varices:
- Get treatment for complications related to alcohol use disorder.
- 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 medications to prevent swollen vessels from developing.
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.
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American College of Gastroenterology http://gi.org
American Gastroenterological Association http://www.gastro.org
Canadian Association of Gastroenterology https://www.cag-acg.org
Canadian Liver Foundation http://www.liver.ca
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