Esophageal varices are unusually widened veins around the esophagus. The esophagus is the tube that connects the mouth to the stomach. These veins may sometimes bleed.
Esophageal varices usually form because of a serious liver disease called cirrhosis. Cirrhosis of the liver can interfere with blood circulation. This leads to increased pressure in the veins around the esophagus. Over time, these veins widen due to the pressure. When the walls of the veins get stretched too much, the veins can break and allow blood to enter the esophagus.
The main cause of bleeding esophageal varices is cirrhosis of the liver. Cirrhosis normally occurs because of long-term alcohol abuse. It can also be caused by hepatitis, a viral infection of the liver.
Symptoms often happen quite suddenly and include:
When an episode of bleeding occurs in the gut, a procedure called endoscopy is often done. A small tube, called an endoscope, is placed through the mouth and into the esophagus and stomach. The tube has a light and a camera on the end of it. This allows the doctor to see the inside of the gut to find the cause of bleeding.
There are several ways to avoid bleeding esophageal varices. They can be prevented by avoiding liver diseases that are caused by long-term alcohol abuse and viral hepatitis. Many cases of hepatitis can be prevented by:
A person with esophageal varices often has serious medical problems due to liver disease. The outcome is generally poor unless a liver transplant is performed. Even after treatment, rebleeding from esophageal varices is common and may lead to death.
There are generally no risks to others unless the person has hepatitis. Hepatitis may be passed on to others through unprotected sex. It may also be passed on by sharing drug needles.
A person with bleeding esophageal varices can lose a lot of blood. Blood transfusions may be required. Other fluids may need to be replaced through an intravenous line.
Endoscopy is done to make sure that varices are the cause of the bleeding. When they are seen, varices can often be treated right away through the endoscope. Tiny instruments can be passed through the tube and used to stop the bleeding.
Sometimes medications are given to cause the varices to shrink. In severe cases, surgery or other procedures may be required to stop the bleeding or to relieve pressure on the swollen varices. Liver transplantation is generally the only way to cure esophageal varices.
Endoscopy and surgery can cause more bleeding, infection, and sometimes even death. Medications used for variceal bleeding may cause salt imbalances, allergic reactions, low blood pressure, or other side effects. Blood transfusions may cause allergic reactions or infections.
If the bleeding stops for more than 1 or 2 days and the person recovers, he or she can usually go home from the hospital.
A person with esophageal varices usually requires lifelong monitoring for the varices and liver problems. Complete blood counts (CBCs), blood pressure, and the heart rate are followed to make sure the bleeding has stopped. Liver function tests and physical examination may be used to monitor the condition of the liver. Any new or worsening symptoms should be reported to the healthcare provider.
Author:Adam Brochert, MD
Editor:Smith, Mary Ellen, BS
Reviewer:Gail Hendrickson, RN, BS
Cecil Textbook of Medicine, 1996, Bennett et al.