Esophageal Varices:
What are esophageal varices?
Esophageal varicies are extra, dilated veins that develop in the lining of the lower esophagus near the stomach. They are caused by liver disease and are similar to the varicose veins that some people develop in their legs. The esophageal varices continue to dilate until they become large enough to rupture. When these swollen veins rupture, the patient can become very ill.
Causes of esophageal varices:
Esophageal varicies are very common among people who have cirrhosis of the liver. Cirrhosis causes scarring of the liver, which slows the flow of blood through the liver. This will cause blood to back up in the portal vein, which is the primary source of blood flowing from the stomach and intestines into the liver. This condition is known as portal hypertension. The back up of blood causes additional blood vessels to develop around the stomach and the esophagus. These extra blood vessels are known as esophageal varices. Blood pressure inside the esophageal varices is much higher than inside a normal blood vessel, and the walls of the varices are much thinner than normal vessels. These structural differences in the varices can cause them to rupture easily and bleed. Approximately 50 percent of patients with esophageal varices will eventually bleed. The mortality rate for esophageal variceal bleeding, on the first event, is between 40 and 70 percent. Mortality is due to multiple factors, which may include: liver failure, sepsis, cerebral edema, exsanguination, or complications associated with anemia.
Symptoms of esophageal varices:
- Vomiting bright red blood or coffee-ground material
- Individual may pass tar/black stool or blood in the stool
- Usually, there are signs of Cirrhosis
- Low blood pressure and rapid heart rate
- Swollen abdomen, red hands, enlarged breasts in males, yellow eyes or skin
- Dizziness
- In severe cases, shock may occur
How are esophageal varices diagnosed?
In order to diagnose esophageal varices, a physician will use an endoscope to look at the walls of the esophagus and identify the source of bleeding. An endoscope is a thin, flexible tube that has a small light and a camera on the end of the tube. The physician will insert the endoscope through the mouth and into the esophagus.
Treatment options:
The treatment for esophageal varices is directed towards immediately controlling the bleeding of the varices. Emergency treatment for bleeding begins by a physician giving the patient both blood and fluids intravenously in order to compensate for the lost blood. At the same time, drugs may be given to the patient in order to decrease the blood flow into the intestines. A physician may then perform an endoscopy in order to locate the source of the bleeding and to further treat the varices.
If bleeding is caused by ruptured esophageal varices, one of the following procedures may be performed by a physician:
- Band ligation: A rubber band is used to tie off the portion of the vein that is bleeding
- Sclerotherapy: A drug is injected into the vein that is bleeding, which causes the vein to narrow and clot.
Once the immediate bleeding is under control, long term treatment methods are performed. For persons with severe cirrhosis, shunting procedures are often necessary, which may include:
- Transjugular intrahepatic portal-systemic shunting (TIPS): A catheter is threaded through a vein in the neck and into the liver. The tip of the catheter holds a stent, which is a small tube that is used to hold open a vein or artery. Under x-ray guidance, the stent is placed in the liver in order to allow blood to flow more easily into the portal vein. This treatment reduces the excess pressure in the esophageal varices and can potentially decrease the risk of additional bleeding in the future.
- Surgery: Similar to the TIPS procedure, surgery can help to decrease the pressure within the esophageal varices.
Related information:
- What is the esophagus?
- American College of Gastroenterology (ACG)
- American Gastroenterological Association (AGA)
- More patient resources
| University of Missouri Health Care | This information is not intended to replace the advice of a doctor. |
