Esophageal Varices

Overview

Definition

Esophageal varices are abnormally swollen veins in the lining of the tube (esophagus) that goes from the mouth to the stomach.

The Esophagus
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Causes

Portal hypertension is when pressure builds in the veins that bring blood to the liver. The pressure causes blood to back up into other smaller blood vessels, such as those found in the esophagus. This leads to varices.

This may happen due to:

  • 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 this problem are:

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

SymptomsandDiagnosis

Symptoms

A person may not have problems until bleeding starts. Bleeding may not be serious. It may also stop on its own. Signs of bleeding are:

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

Diagnosis

You will be asked about your symptoms and health history. A physical may be done.

The esophagus may need to be viewed. This can be done with:

  • An upper GI endoscopy to look at the structures from the back of the throat to the stomach
  • Ultrasound
  • CT scan

Treatments

Treatment

The goal is to prevent or stop varices from bleeding. Choices are:

Medicines

Medicines may be given to lower blood pressure or cholesterol. This will help lower the risk of bleeding or slow any bleeding that is happening

Procedures

Procedures may be done, 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.

Prevention

There are no known guidelines to lower the risk of this problem.

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.

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

de Franchis R, Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015 Sep;63(3):743-752.

Esophageal varices. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/esophageal-varices. Accessed October 21, 2020.