Esophageal Varices

What are esophageal varices?

Esophageal varices are enlarged veins that occur 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 sudden and severe bleeding. Because of this risk of bleeding, esophageal varices are a serious, possibly life-threatening problem.

How does it occur?

The most common cause of esophageal varices is scarring of the liver. The scarring may be caused by liver disease, such as cirrhosis. The scarring prevents the normal flow of blood from the intestines back through the liver. The blood bypasses the liver, increasing the blood flow into the veins of the esophagus. As this condition worsens, the body creates new veins, but these new veins cannot prevent abnormally high pressures and swelling of the veins. At any time the veins can break open and cause severe bleeding.

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).

How is it treated?

Varices that have not caused bleeding may be treated with medicine. Beta blockers or nitrates may be prescribed. The medicine will reduce the risk of bleeding.

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 see if the bleeding has stopped.

Your healthcare provider will try to help you prevent worsening of the condition that is causing the scarring, such as cirrhosis.

How can I take care of myself?

Be sure to follow your 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.

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.