Esophageal Varices

Overview

The portal system includes veins stemming from the stomach, intestines, spleen and pancreas, which merge into the portal vein and travel to the liver. If blood vessels in the liver are blocked because of liver damage, the obstruction can cause increased blood pressure among the veins in the portal system. Portal hypertension causes blood to be rerouted and pushed into smaller veins that cannot handle increased blood flow. This can result in the development of large, swollen veins or varices, in the stomach, rectum, umbilical area or esophagus. Varices may rupture and cause internal bleeding, which can be potentially life-threatening.

The most common causes of esophageal varices include:

Scarring of the liver or cirrhosis—Many liver diseases can cause cirrhosis such as hepatitis, alcoholic liver disease, fatty liver disease and bile duct disorders. About 40 percent of people who have cirrhosis develop esophageal varices.
Thrombosis (blood clots)—A clot in the portal vein or feeder vein into the portal vein can cause varices.
Parasite infection—Schistosomiasis is a parasitic infection that can damage the lungs, intestines, bladder and liver.
Budd-Chiari syndrome—This is a rare condition that can cause blood clots in the hepatic system.

Diagnosis

It is important to know the warning signs of bleeding esophageal varices and visit your doctor or emergency room immediately.
Warning signs may include:

Bloody stools
Tarry stools
Light-headedness
Paleness
Symptoms of chronic liver disease
Vomiting
Vomiting blood
Low blood pressure
Rapid heart rate
Shock

Your doctor may be able to diagnose bleeding esophageal varices by inserting a tube through the nose and into the stomach to detect the presence of blood. Another method is called an esophagogastroduodenoscopy (EGD), a test that uses a flexible tube with a camera to view the upper gastrointestinal system. If your doctor determines that you have bleeding varices, you will need to have immediate treatment to stop the bleeding and prevent further bleeding. Uncontrolled bleeding can result in shock and death.

Prevention and Treatment

You can make some daily changes in habits and diet to help prevent esophageal varices. Although there is no treatment to prevent the formation of varices, you can take steps to keep your liver healthy such as:

Avoiding alcohol—Because alcohol is processed in the liver, eliminate alcohol. Drinking alcohol can cause more scarring and increase pressure in the portal system.
Eating a healthy diet—Reduce intake of fatty and fried foods and increase servings of fruits, vegetables and whole grains.
Maintaining or achieving a healthy weight—Obesity increases the risk of cirrhosis.
Being cautious with chemicals—The liver is responsible for removing toxins from your body, so limit the toxins your liver is processing.
Medication can also be perscribed to reduce pressure in the portal vein. A type of blood pressure drug called a beta blocker may help reduce blood pressure in your portal vein, decreasing the likelihood of bleeding.

Variceal banding is one method of treatment for esophageal varices that are at risk for rupturing. Your doctor will use a lighted endoscope and place an elastic band around the bleeding esophageal vein. Banding the vein will cut off blood flow through the vein. The banded tissue develops into a small ulceration that quickly heals after several days or a few weeks. This procedure is safe, it does not damage the esophageal wall, and it does not increase pressure in the portal system.

Another surgical option is a procedure called called transjugular intrahepatic portosystemic shunt (TIPS). The shunt is a small tube that is placed between the portal vein and the hepatic vein, which carries blood from your liver back to your heart. By providing an additional path for blood, the shunt reduces pressure in the portal vein and often stops bleeding from esophageal varices. TIPS is mainly used when all other treatments have failed or as a temporary measure in people awaiting a liver transplant.

Liver transplant is an option for people with severe liver disease or those who experience recurrent bleeding of esophageal varices. Although liver transplantation is often successful, the number of people awaiting transplants far outnumbers the available organs.