Are Bleeding Esophageal Varices?
Bleeding esophageal varices occur when swollen veins (varices) in
your lower esophagus rupture and bleed.
The esophagus is the muscular tube that connects your mouth to
your stomach. The veins in your lower esophagus can become swollen when blood
flow to the liver is reduced. This may be due to scar tissue or a blood clot.
When blood flow is obstructed, blood builds up in other blood
vessels nearby, including those in your lower esophagus. However, these veins
are much smaller and incapable of carrying large amounts of blood. They dilate
and swell as a result of the increased blood flow.
The swollen veins are known as esophageal varices.
Esophageal varices may leak blood and eventually rupture. This
can lead to severe bleeding and life-threatening complications. When this
happens, it’s a medical emergency. Call 911 or go to the nearest emergency room
right away if you’re showing symptoms of bleeding esophageal varices.
Are the Symptoms of Bleeding Esophageal Varices?
Esophageal varices are unlikely to cause symptoms unless they
have ruptured. When this happens, you may experience:
- hematemesis (blood in your vomit)
- stomach pain
- melena (black stools)
- bloody stools (only in severe cases)
- shock (only in severe cases, due to blood loss)
Call 911 or go to the nearest emergency room immediately if
you experience any of the above symptoms.
Causes Bleeding Esophageal Varices?
The portal vein transports blood from several organs in the
gastrointestinal tract to the liver. Esophageal varices are a direct result of
high blood pressure in the portal vein. This condition is called portal hypertension.
It causes blood to build up in nearby blood vessels, including those in your
esophagus. Veins begin to dilate and swell as a result of increased blow flow.
Cirrhosis is the most common cause of portal hypertension. Cirrhosis is a severe
scarring of the liver that often develops due to excessive alcohol consumption or
serious infections, such as hepatitis. Another potential cause of portal
hypertension is portal vein thrombosis, a condition that occurs when blood clots
inside the portal vein.
In some cases, the cause of portal hypertension is unknown. This
is referred to as idiopathic portal hypertension.
Are the Risk Factors for Bleeding Esophageal Varices?
Esophageal varices are more likely to bleed if you have:
- large esophageal varices
- red marks on the esophageal varices
- portal hypertension
- severe cirrhosis
- a bacterial infection
- excessive alcohol use
Speak with your doctor about your risk of developing esophageal
varices, especially if you have a family history of liver disease.
Bleeding Esophageal Varices
To diagnose esophageal varices, your doctor will perform a
physical examination and ask you about your symptoms. They may also use one or
more of the following tests to confirm the diagnosis:
- blood tests: to assess the amount of bloodflow
through your veins
- endoscopy: to evaluate dilated, swollen veins
- imaging tests, such as CT and MRI scans: to
examine the liver and the veins in your lower esophagus
Bleeding Esophageal Varices
The main goal of treatment is to prevent esophageal varices from
rupturing and bleeding.
Controlling Portal Hypertension
Controlling portal hypertension is usually the first step in
lowering the risk of bleeding. This may be achieved through the use of the
following treatments and medications:
Your doctor may prescribe beta-blocker medications, such as propranolol,
to lower your blood pressure.
sclerotherapy: Using an endoscope, your doctor will inject a
medication into your swollen veins that will shrink them. An endoscope is a
long, flexible tube with a light and camera attached to it. This device is commonly
used to look inside a body cavity or an organ.
variceal ligation (banding): Your doctor will use an endoscope to tie
off the swollen veins in your esophagus with an elastic band so they can’t
bleed. They’ll remove the bands after a few days.
You may need more treatment if your esophageal varices have
After Bleeding Has Begun
Endoscopic variceal ligation and endoscopic sclerotherapy are generally
preventive treatments. However, your doctor can also use them if your
esophageal varices have already begun to bleed. A medication called octreotide may
be used as well. This drug will lower the pressure in the swollen veins by tightening
the blood vessels and reducing blood flow.
Transjugular intrahepatic portosystemic shunt is another
potential treatment option for bleeding esophageal varices. This is a surgical
procedure that creates new connections between two blood vessels in your liver.
A small tube is used to connect the portal vein with the hepatic
vein. The hepatic vein transports blood from the liver to the heart. This
connection creates a diversion for the blood flow.
In rare cases, a liver transplant may be necessary.
Outlook for People with Bleeding Esophageal Varices
Bleeding will continue to occur if the condition isn’t treated promptly.
Without treatment, bleeding esophageal varices can be fatal.
After you receive treatment for bleeding esophageal varices, you
must attend regular follow-up appointments with your doctor to make sure the
treatment was successful.
Can Esophageal Varices Be Prevented?
The best way to prevent esophageal varices is to correct the
underlying cause. If you have liver disease, consider the following preventive
measures to reduce your risk of developing esophageal varices:
- Eat a healthy diet that largely consists of lean
protein, whole grains, fruits, and vegetables.
- Stop drinking alcohol.
- Maintain a healthy weight.
- Lower your risk for hepatitis by practicing safe
sex. Don’t share needles or razors, and avoid contact with the blood and other
bodily fluids of an infected person.
It’s very important to stick with your treatment plan and attend
regular appointments with your doctor if you have esophageal varices. Call 911
or go to the hospital immediately if you believe your esophageal varices have
ruptured. Bleeding esophageal varices are life-threatening and can lead to