Overview
Esophageal varices are enlarged, swollen veins in the lower part of the esophagus. They develop as a complication of portal hypertension (high blood pressure in the portal vein), which is often associated with cirrhosis. This pressure causes the veins to enlarge which can rupture and cause life-threatening bleeding. Causes of esophageal varices can include portal hypertension, chronic liver disease including cirrhosis, hepatitis B and C and alcohol-related liver disease. Symptoms of esophageal varices include bleeding, jaundice, edema, upper abdominal pain, fluid buildup in the abdomen and itching. If a varices has ruptured, you might have symptoms that include vomiting blood, black stools, or feeling lightheaded or faint due to blood loss.
How is it diagnosed?
- Upper endoscopy: This is usually the main source to diagnosis esophageal varices. The physician will look for dilated veins and if red spots or streaks are seen, this usually indicates a substantial risk of bleeding.
- Imaging studies: CT scan and ultrasounds can be used to measure if you have scarring on the liver, which can lead to esophageal varices.
How is it treated?
Prevention of bleeding is the biggest goal. Medications that slow the flow of blood to the portal vein or variceal band ligation can be used to reduce the risk of variceal bleeding. If you have acute or sudden bleeding episodes, those require immediate medical attention and may be treated with endoscopic therapy like band ligation, blood transfusions, liver transplant and possibly placement of a trans-jugular intrahepatic portosystemic shunt (TIPS). Patients with known esophageal varices require regular endoscopic surveillance to monitor for variceal progression and to guide preventive interventions.
Image courtesy of Cleveland Clinic
References
Cleveland Clinic. 2023. Esophageal Varices. https://my.clevelandclinic.org/health/diseases/15429-esophageal-varices
Mayo Clinic. 2023. Esophageal Varices. https://www.mayoclinic.org/diseases-conditions/esophageal-varices/diagnosis-treatment/drc-20351544
