Esophageal Varices

What Is It?

Esophageal varices are extra, swollen 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 have in their legs. These swollen veins can rupture and cause dangerous bleeding.

Esophageal varices almost always occur in people who have cirrhosis of the liver. Cirrhosis causes scarring of the liver, which slows the flow of blood through the liver. This causes blood to back up in the portal vein, the main vein that delivers blood from the stomach and intestines to the liver. This condition is called portal hypertension. The backup of blood forces extra blood vessels to form around the stomach and esophagus. These extra vessels are called esophageal varices. They usually have enlarged, irregularly shaped bulbous regions (varicosities) that are interrupted by narrower regions. Because the blood pressure inside the varices is higher than inside normal blood vessels, and the walls of the vessels are thin, they rupture easily and can bleed profusely.

Symptoms

Portal hypertension often does not cause any symptoms, and sometimes is discovered only when the varices bleed. When significant bleeding occurs, patients will vomit blood, often in large amounts. People with massive bleeding frequently feel dizzy, and may lose consciousness. Some people bleed in smaller amounts over a longer period of time, and they swallow the blood rather than vomit. Their stools may contain red or tarry-black blood. People with either type of bleeding from the esophagus usually also have symptoms of cirrhosis of the liver.

Diagnosis

To diagnose esophageal varices, a doctor will use an instrument called an endoscope, a thin, flexible tube with a camera at its tip that is inserted through the mouth so the doctor can see the walls of the esophagus and search for the source of bleeding. Tiny instruments may be attached to the endoscope to provide treatment at the same time.

Expected Duration

Bleeding from esophageal varices can stop on its own or with treatment. However, bleeding esophageal varices can be fatal, particularly in people with severe liver disease. Half or more of patients who survive episodes of bleeding from esophageal varices will have the problem return during the first one to two years. The risk of recurrence can be reduced with treatment.

Prevention

The best way to prevent esophageal varices is to reduce your risk of cirrhosis. The main cause of cirrhosis is alcohol abuse. Patients with hepatitis B or hepatitis C also are at risk of developing cirrhosis. Intravenous drug use is a major risk factor for hepatitis B and C. Children, young teens and all health care workers and older adults at risk of hepatitis B should be vaccinated against the disease. There is no vaccine to prevent people from contracting hepatitis C.