Esophageal varices occur when the lining of the esophagus swells, typically due to a type of liver disease, such as cirrhosis. While you can’t see or feel these deep chest veins, they can rupture and become life-threatening. Treatment focuses on damage control to stop active bleeding and prevent recurrence.
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What Are Esophageal Varices?
The esophagus is the “food pipe” that connects your throat to your stomach. Esophageal varices happen when veins in the esophagus become enlarged.
Esophageal varices occur most often in people with cirrhosis or scarring of the liver.
At least half the people who have cirrhosis end up with these swollen veins. They often appear in the lower part of the esophagus, near the stomach.
Because they can burst and bleed spontaneously, esophageal varices can be life-threatening.
How common are esophageal varices?
While esophageal varices are not common for people with healthy livers, they are common in people who have cirrhosis. Up to 30% or people who have cirrhosis also have esophageal varices.
What causes esophageal varices?
Portal hypertension is the main cause of esophageal varices. Portal hypertension is a condition caused by high blood pressure in the portal vein system, which supplies blood to the liver. It's not the same as regular high blood pressure.
Cirrhosis of the liver is almost always the cause of portal hypertension.
Scarring decreases the amount of blood that can pass through the liver, and the blood has to find new pathways. Sometimes those pathways are veins in the esophagus and stomach.
Since these veins can't handle a high volume of blood, they can develop bulges that leak blood or rupture. These bulges are esophageal varices.
Esophageal varices risk factors
Anyone with liver disease is at risk for esophageal varices, but cirrhosis is the most common risk factor.
If you've had one episode of bleeding esophageal varices, you're likely to have more.
Other risk factors for developing liver disease include:
- Alcohol dependency.
- Hepatitis.
- Obesity.
Complications of esophageal varices
The increased blood flow in the veins of the esophagus and stomach can stretch parts of the veins like balloons. If the vein bursts, bleeding can cause shock and death if you don't get treatment right away.
How can I prevent esophageal varices?
The only way to prevent this condition is to keep your liver healthy. People who drink too much alcohol or have hepatitis are at risk for liver disease.
If you have liver disease, you can prevent further damage by:
- Eating a healthy diet.
- Maintaining a healthy weight.
- Not drinking alcohol.
- Seeing your liver doctor on a routine basis.
What Are the Signs and Symptoms of Esophageal Varices?
People with this liver condition often don't have symptoms until a vein ruptures. When this happens, you need to seek treatment right away. Call 911 or go to the nearest emergency room.
Signs that a vein has burst include:
- Black, tarry stools — If blood passes in stool, it will appear black, but red blood may appear as well.
- Pale skin — Indicates significant blood loss.
- Shock or lightheadedness — May be signs of low blood pressure.
- Vomiting blood — If blood is leaking slowly, you may vomit coagulated blood that resembles coffee grounds. Fresh blood may also appear in vomit if a vein has ruptured.
In severe cases, you may:
- Become dizzy or lose consciousness — Emergency care is critical if someone passes out from a ruptured vein. Find a hospital or call 911.
When should I see a doctor about my esophageal varices symptoms?
If you are experiencing any of the above symptoms, find an emergency room or call 911 right away. A ruptured vein can be deadly.
How Do You Diagnose Esophageal Varices?
If you have cirrhosis, your doctor will screen you routinely for esophageal varices.
Tests include:
- Blood tests — Doctors will look at your blood counts and liver function.
- Endoscopy — Doctors insert a thin, flexible tube (endoscope) through your mouth. It goes down your esophagus and into your stomach. They can view and treat varices through the endoscope.
- Imaging tests — CT and MRI scans can show blood flow around the liver and other organs.
Esophageal varices prognosis
Once you have been diagnosed with esophageal varices, it’s important to continue talking with your health care provider to monitor the condition. While treatment can help reduce varices, bleeding can still recur.
Other factors that determine someone’s overall prognosis with esophageal varices include:
- History of bleeding.
- Overall health.
- Stage of liver disease.
How Do You Treat Esophageal Varices?
Doctors focus on damage control to treat esophageal varices. They want to control the bleeding, prevent recurrence, and reduce other health complications, such as portal hypertension, that cause ruptured veins. They may use medical techniques or certain medications to help treat the condition.
Medical techniques to treat esophageal varices
- Banding — The doctor uses an endoscope to place an elastic ring around the enlarged vein. The ring cuts off blood flow to the vein, so it won't burst. Doctors can repeat the banding process many times.
- Endoscopic sclerotherapy — Doctors inject a sclerosant chemical into the enlarged vein or wall of the esophagus. The chemical causes inflammation of the vein's lining, which in turn causes the vein to close off and scar. Doctors often use this treatment in emergencies and follow it with variceal banding.
- Transjugular intrahepatic portosystemic shunt (TIPS) — Used to reduce portal hypertension by bypassing the damaged liver. Doctors connect the portal vein to the hepatic vein and insert a stent to increase blood flow around the liver. Because the blood has a new pathway, it eases pressure on the veins of the esophagus and stomach.
Medicine to treat esophageal varices
Along with other treatments, doctors often prescribe drugs to manage esophageal varices, such as:
- Beta blockers — These medicines slow the heart rate and widen the blood vessels. This lowers blood pressure in veins that bypass the liver. Beta blockers reduce the risk of having a first episode of bleeding.
- Vasoconstrictor medicines — These drugs constrict blood vessels and reduce blood flow to the portal vein. Doctors use them to treat sudden bleeding from varices.
