Esophgeal Varices

February 7, 2017

Esophageal varices are swollen blood vessels in the tube that carries food from your mouth to your stomach (the esophagus), and in the upper part of the stomach. Varices cause no symptoms unless they rupture and bleed, which can be a medical emergency.

The esophagus is the tube that lies between the pharynx (at the top of the throat) and the stomach. The esophagus has prolific veins at the base for delivering blood to the liver for detoxification or nutrient removal from the body.

Varices most often occur because of problems with blood flow in the liver that are caused by chronic liver disease. Normally, a blood vessel called the portal vein carries blood from the digestive organs to the liver. But with liver disease, blood flow can become blocked because of scarring of the liver. This increases the blood pressure in the portal vein (a condition known as portal hypertension). Blood then backs up in nearby veins in the esophagus and stomach, causing varices. Varices are a serious and life-threatening problem. Treatment is needed to prevent them from rupturing and bleeding. If bleeding occurs, it can be fatal.

A number of drugs and medical procedures can help prevent and stop bleeding from esophageal varices.


Increased pressure in the veins that deliver blood to the liver is known as portal hypertension. The increased pressure causes blood to back up into other smaller vessels, including those of the esophagus. This leads to the formation of esophageal varices.

The medical conditions that lead to the development of portal hypertension and esophageal varices include –

  • Cirrhosis of the liver
  • Blood clots of the splenic, portal, or hepatic veins
  • Arterial-portal venous fistula—abnormal connections between arteries and veins in the liver or spleen
  • Certain infections
  • Severe heart failure
  • Hodgkin’s disease
  • Sarcoidosis

Risk Factors

  • High portal vein pressure -The risk of bleeding increases with the amount of pressure in the portal vein (portal hypertension).
  • Large varices – The larger the varices, the more likely they are to bleed.
  • Red marks on the varices – When viewed through an endoscope passed down the throat, some varices show long, red streaks or red spots. These marks indicate a high risk of bleeding.
  • Severe cirrhosis or liver failure – Most often, the more severe the liver disease, the more likely varices are to bleed.
  • Continued alcohol use


Esophageal varices usually don’t cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices include –

  • Vomiting blood
  • Black, tarry or bloody stools
  • Shock (in severe case)
  • Yellow coloration of your skin and eyes (jaundice)
  • A cluster of tiny blood vessels on the skin, shaped like a spider (spider nevi)
  • Reddening of the skin on the palm of your hands (palmar erythema)
  • A hand deformity known as Dupuytren’s contracture
  • Shrunken testicles
  • Swollen spleen
  • Fluid buildup in your abdomen (ascites)


  • Encephalopathy (sometimes called hepatic encephalopathy)
  • Esophageal stricture after surgery or endoscopic therapy
  • Hypovolemic shock
  • Infection (pneumonia, bloodstream infection, peritonitis)
  • Return of bleeding after treatment


Medications – These may be prescribed to lower the blood pressure inside the enlarged veins. This reduces the risk of bleeding. Beta-blockers are the most common medication used.

Endoscopic therapy – These are treatments for enlarged or bleeding veins that are done with the help of an endoscope. With ligation, small rubber bands are placed around the veins to close them off and stop any bleeding. With sclerotherapy, clotting medication is injected into the veins to cause scarring and shrink them.

Balloon tamponade – This is a procedure in which a tube with a balloon is guided down into the esophagus and stomach. The balloon is then inflated with air. This applies pressure on enlarged or bleeding veins to control bleeding. This is a temporary method to control bleeding until other treatments are available.

Surgery – This may be done to place a stent (tubelike device) in the liver. The stent helps reroute blood flow in the liver to lower the blood pressure in enlarged veins. Sometimes, the enlarged veins may be connected to other nearby veins to reroute blood flow. In severe cases, a liver transplant may be needed. This is to replace the diseased liver with a healthy donor liver.

Alternative & Complementary Treatment

Alternative treatments are aimed at preventing the development of progression of cirrhosis of the liver. By halting the hardening of liver tissue, this approach serves to maintain the best hepatic circulation possible, ultimately reducing the risk of bleeding esophogeal varices. However, once a patient has reached the bleeding stage, standard medical intervention is required. Some popular alternative treatments to prevent liver disease progression include:

Herbal Supplements – The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, like medications, contain active substances capable of triggering side effects and interacting with other herbs, supplements or medications. Therefore, herbs should be taken with a physician’s consent. Milk thistle is one of the most reputed herbs for supporting the liver and preventing cirrhosis progression.

Acupuncture – According to a 1997 Consensus Statement by the National Institutes of Health, acupuncture is an effective adjunct treatment for addiction, including alcoholism. For a person with alcohol-related cirrhosis, anything to help maintain abstinence is a sound preventative method. In addition, this centuries old therapy has been shown to increase hepatic circulation and decrease blood pressure.

Dietary Counseling – Malnutrition is typically a problem for people with cirrhosis. Because the liver processes and is affected by everything we ingest, eating a healthy diet is an important part of treatment for cirrhosis. A dietician or nutritionist can guide a person to change their diet and consume foods that will benefit their particular body.


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