Esophageal Varices

What are esophageal varices?

Esophageal varices are swollen veins in the walls of the esophagus. The esophagus is the tube that connects your throat to your stomach. The pressure in the swollen veins is higher than normal. The increased pressure can cause the veins to suddenly break open, resulting in sudden and severe bleeding. Because of this risk of bleeding, esophageal varices are a serious, possibly life-threatening problem.

What is the cause?

The most common cause of esophageal varices is scarring of the liver. The scarring is called cirrhosis. Cirrhosis can be caused by several medical conditions. Examples are alcoholic liver disease, hepatitis B or C infections, and hemochromatosis, a condition of having too much iron in your body. The scarring prevents the normal flow of blood from the intestines back through the liver. The blood bypasses the liver, increasing the blood flow and pressure in the veins of the esophagus.

Rarely, esophageal varices are caused by other medical problems.

What are the symptoms?

Unless you have bleeding, you may have no symptoms of the varices. At first you may have just small amounts of bleeding, which is passed on through the digestive system. You may see dark or black tarry digested blood in your bowel movements. As bleeding increases, you may have dark red or black diarrhea. You may start vomiting bright red blood.

How is it diagnosed?

Your healthcare provider may suspect that you have esophageal varices if you have advanced liver disease.

Varices may be diagnosed with these tests:

• Endoscopy, in which a thin flexible tube with a tiny camera is inserted through your mouth down into your upper digestive tract. Your healthcare provider can find the sites of bleeding.
• Upper GI X-rays, for which you swallow liquid barium so your healthcare provider can see the varices (the barium outlines the varices on the X-ray)
• CT or MRI scans of the esophagus.

How is it treated?

Varices that haven’t bled yet may be treated with medicine, such as beta blockers or nitrates. The medicine will reduce the risk of bleeding by lowering the blood pressure in the varicose veins.

Emergency treatment for varices that are bleeding includes medicine and intravenous (IV) fluids. Several methods may be used to prevent further bleeding, such as:

• injection of medicine into the veins to cause them to scar and close
• placement of tight bands around the bulging veins to close them off
• oral or IV medicine, such as beta blockers, vitamin K, and nitrates
• balloon tamponade (A tube with an empty balloon at the end is put into the esophagus where the bleeding is. The balloon is filled with air. The pressure of the filled balloon stops the bleeding.)

Several of the treatments require endoscopy so your provider can see the veins and apply the medicine or the bands. Endoscopy is also used after treatment to make sure the bleeding has stopped.

Your healthcare provider will try to help you prevent worsening of the condition that is causing liver scarring.

How can I take care of myself?

Be sure to follow your healthcare provider's instructions for medicine, diet, and activity to try to prevent bleeding. If you have alcoholic cirrhosis, it is very important to get help to stop drinking.

Getting infectious hepatitis will make your liver scarring worse. Ask your provider if you need shots to prevent hepatitis A or B. There is no vaccine against hepatitis C.

It’s important not to irritate the varicose veins and cause them to bleed. This means avoiding coughing and vomiting as much as possible. If you need help preventing these problems, ask your provider.

How can I help prevent esophageal varices?

The only way to prevent esophageal varices is to try to prevent the underlying causes, such as liver disease.