Bleeding esophageal varices
Key points
- Bleeding esophageal varices result from dilated veins in the walls of the lower part of the esophagus and sometimes the upper part of the stomach.
- Bleeding varices are a life-threatening complication of portal hypertension (increased blood pressure in the portal vein caused by liver disease).
- Tests to localize bleeding and detect active bleeding include the insertion of a tube through the nose and down into the stomach to look for signs of bleeding (nasogastric or "NG" tube).
- The objective of therapy is to stop acute bleeding as soon as possible and manage persistent varices with medical and procedural therapies.
Definition
Bleeding esophageal varices result from dilated veins in the walls of the lower part of the esophagus and sometimes the upper part of the stomach.
Causes, incidence, and risk factors
Bleeding varices are a life-threatening complication of portal hypertension (increased blood pressure in the portal vein caused by liver disease). Increased pressure causes the veins to balloon outward. The vessels may rupture, causing vomiting of blood and bloody stools or tarry black stools. If a large volume of blood is lost, signs of shock will develop. Any cause of chronic liver disease can cause bleeding varices.
Symptoms
- Vomiting
- Vomiting blood
- Black, tarry stools
- Bloody stools
- Decreased urine output
- Symptoms of chronic liver disease (such as cirrhosis)
- Excessive thirst
- Paleness
- Light-headedness
Signs and tests
Physical examination:
- Signs of chronic liver disease or cirrhosis
- Low blood pressure
- Rapid heart rate
- Bloody or black stool on rectal exam
Tests to localize bleeding and detect active bleeding include the insertion of a tube through the nose and down into the stomach to look for signs of bleeding (nasogastric or "NG" tube). Tests to visualize the varices include EGD (esophagogastroduodenoscopy).
Treatment
The objective of therapy is to stop acute bleeding as soon as possible and manage persistent varices with medical and procedural therapies. Bleeding must be controlled quickly to prevent shock and death. If massive bleeding occurs, the patient may be placed on a ventilator to protect the airway and prevent blood from going down into the lungs.
In endoscopic therapy, an endoscope (a device with a light that can look inside of a body cavity) is used. The health care provider may directly inject the varices with a clotting agent or place a rubber band around the bleeding veins. This procedure is used in acute bleeding episodes and as prophylactic (preventive) therapy.
Acute bleeding may also be treated by a balloon tamponade - a tube that is inserted through the nose into the stomach and inflated with air to produce pressure against the bleeding veins.
Written and revised by
Andrey Nailor, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
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