Esophageal Varices

What are esophageal varices?

Esophageal varices are swollen blood vessels in the esophagus (swallowing tube), the tube that connects the mouth to the stomach. Esophageal varices may appear in people with serious liver disease.

What causes esophageal varices?

Esophageal varices occur when normal blood flow to your liver is slowed. Liver disease may create scar tissue in the liver which slows the flow of blood. When the blood to your liver is slowed, it begins to back up, leading to an increase of pressure in the major vein (portal vein) that carries blood to your liver. This increase pressure forces the nearby smaller veins to swell, such as those in your esophagus.

What are the symptoms of esophageal varices?

Esophageal varices do not cause symptoms unless they leak or burst. A leaking esophageal varices causes bleeding which can be very serious. Signs of bleeding from esophageal varices include, vomiting blood; dark-colored or black bowel movements; feeling lightheaded and passing out. If you get these symptoms, your doctor should know and/or call 9-1-1.

How are esophageal varices diagnosed?

A test called an upper endoscopy can be done to check for esophageal varices. The doctor puts a thin, flexible tube into your mouth down your throat and into your esophagus. The tube (called an endoscope) has a camera and light on it which the doctor can see inside your esophagus and stomach. This may be done in our endoscopy center with IV (intravenous) sedation to provide comfort. Sometimes, doctors do a test using a small capsule with a tiny camera inside. The capsule sends photos of the lining of your esophagus and stomach to a device outside your body. A doctor then looks for any problems in the photos.

How are esophageal varices treated?

Treatment for esophageal varices is to prevent them from bleeding and treating the underlying liver disease.

• Don’t drink alcohol. Alcohol can stress an already vulnerable liver.
• Keep a healthy weight. Lose weight, if you are overweight, as excess weight can damage your liver.
• Eat a health diet. Try to avoid salty, fatty and fried foods.
• Reduce your risk of getting hepatitis such as alcohol, sharing needles and unprotected sex. Get vaccinated for hepatitis.
• Your doctor should know what medicines, vitamins and supplements you take.
• Medicines to try and lower the pressure in the major liver veins, called beta-blockers, may be ordered.
• Taking medicines that lower the amount of acid in your stomach while varices heal.
• If you are likely to have bleeding from varices, during an upper endoscopy a variceal band ligation can be done. The doctor will place small rubber bands around the varices to stop the bleeding. Variceal band ligation has to be repeated until the varices are gone.
• People who have severe bleeding need to have a procedure called a “TIPS”. This is done in the hospital, where a doctor inserts a thin tube through a vein in the neck and places the tube inside the liver. The tube helps blood to flow through the liver more easily and lowers the blood pressure in the varices to help stop bleeding.
• Cirrhosis is a term used to describe a diseased liver that has been severely scarred, usually due to years of injury and disease. The most common causes of cirrhosis include longstanding alcohol abuse, chronic hepatitis and nonalcoholic steatohepatitis (fat builds up in the liver and the liver becomes inflamed). Although cirrhosis can not be cured, the key is to prevent the disease from worsening.
• For severe liver disease, a liver transplant, replacing the diseased liver with a healthy one, may be an option.