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Esophageal Varices

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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.

Causes of esophageal varices

Portal hypertension is the main cause of esophageal varices.

Portal hypertension is high blood pressure in the portal vein system that delivers 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 are esophageal varices.

Esophageal varices risk factors and complications

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.

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 to 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.

Why choose the UPMC Center for Liver Care for care?

  • Our world-renowned doctors diagnose and treat all types of liver diseases, including esophageal varices.
  • Our center offers cutting-edge treatments for people with even the most complex liver conditions.
  • We're home to one of the oldest and most experienced transplant centers in the country.

Esophageal Varices Symptoms and Diagnosis

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:

  • Vomiting blood.
  • Stomach pain.
  • Becoming dizzy or losing consciousness.
  • Black, tarry stools.
  • Shock.

Diagnosing 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.
  • Imaging tests. CT and MRI scans can show blood flow around the liver and other organs.
  • 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.

Esophageal Varices Treatment

At the UPMC Center for Liver Care, our doctors are experts in treating esophageal varices.

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 chemical (sclerosant) into the enlarged vein or wall of the esophagus. This 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 followed by variceal banding.

Transjugular intrahepatic portosystemic shunt (TIPS) 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:

  • Vasoconstrictor medicines. These drugs constrict blood vessels and reduce blood flow to the portal vein. Doctors use them to treat sudden bleeding from varices.
  • 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.