Bleeding esophageal varices
The esophagus (food pipe) is the tube that connects your throat to your stomach. Varices are enlarged veins that may be found in the esophagus in people with cirrhosis of the liver. These veins may rupture and bleed.
Liver cirrhosis - varices; Cryptogenic chronic liver disease - varices; End-stage liver disease - varices; Alcoholic liver disease - varices
Scarring (cirrhosis) of the liver is the most common cause of esophageal varices. This scarring cuts down on blood flowing through the liver. As a result, more blood flows through the veins of the esophagus.
The extra blood flow causes the veins in the esophagus to balloon outward. Heavy bleeding can occur if the veins tear.
Any type of long-term (chronic) liver disease can cause esophageal varices.
Varices can also occur in the upper part of the stomach.
People with chronic liver disease and esophageal varices may have no symptoms.
If there is only a small amount of bleeding, the only symptom may be dark or black streaks in the stools.
If larger amounts of bleeding occur, symptoms may include:
Exams and Tests
Your health care provider will do a physical exam which may show:
Tests to find the source of the bleeding and check if there is active bleeding include:
Some providers suggest EGD for people who are newly diagnosed with mild to moderate cirrhosis. This test screens for esophageal varices and treats them before there is bleeding.
If massive bleeding occurs, a person may need to be put on a ventilator to protect their airway and prevent blood from going down into the lungs.
To stop the bleeding, the provider may pass an endoscope (tube with a small light at the end) into the esophagus:
Other treatments to stop the bleeding:
Once the bleeding is stopped, other varices can be treated with medicines and medical procedures to prevent future bleeding. These include:
In rare cases, emergency surgery may be used to treat people if other treatment fails. Portacaval shunts or surgery to reduce the pressure in the esophageal varices are treatment options, but these procedures are risky.
People with bleeding varices from liver disease may need more treatment for their liver disease, including a liver transplant.
Bleeding often comes back with or without treatment.
Bleeding esophageal varices are a serious complication of liver disease and have a poor outcome.
Placement of a shunt can lead to decrease of blood supply to the brain. This can lead to mental status changes.
Future problems caused by varices may include:
When to Contact a Medical Professional
Call your provider or go to an emergency room if you vomit blood or have black tarry stools.
Treating the causes of liver disease may prevent bleeding. Liver transplantation should be considered for some people.
Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 144.
Savides TJ, Jensen DM. Gastrointestinal bleeding. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 20.
Review Date: 10/15/2019
Reviewed By: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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