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Esophageal varices

Esophageal varices are abnormal, enlarged veins in the lower part of the esophagus — the tube that connects the throat and stomach. Esophageal varices occur most often in people with serious liver diseases.

Esophageal varices develop when normal blood flow to the liver is obstructed by scar tissue in the liver or a clot. Seeking a way around the blockages, blood flows into smaller blood vessels that are not designed to carry large volumes of blood. The vessels may leak blood or even rupture, causing life-threatening bleeding.

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

Symptoms Causes Risk factors Complications Prevention

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)

Your doctor may suspect varices if you have any of the following signs of liver disease:

  • 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)

When to see a doctor

Make an appointment with your doctor if you have any signs or symptoms that worry you. If you've been diagnosed with liver disease, ask your doctor about your risk of esophageal varices and how you may reduce your risk of these complications. Ask your doctor whether you should undergo an endoscopy procedure to check for esophageal varices.

If you've been diagnosed with esophageal varices, your doctor may instruct you to be vigilant for signs of bleeding. Bleeding esophageal varices are an emergency. Call 911 or your local emergency services right away if you experience bloody vomit or bloody stools.

Esophageal varices sometimes form when blood flow to your liver is obstructed, most often by scar tissue in the liver caused by liver disease. The blood flow to your liver begins to back up, increasing pressure within the large vein (portal vein) that carries blood to your liver. This pressure (portal hypertension) forces the blood to seek alternate pathways through smaller veins, such as those in the lowest part of the esophagus. These thin-walled veins balloon with the added blood. Sometimes the veins can rupture and bleed.

Causes of esophageal varices include:

  • Severe liver scarring (cirrhosis). A number of liver diseases can result in cirrhosis, such as hepatitis infection, alcoholic liver disease, fatty liver disease and a bile duct disorder called primary biliary cirrhosis. Esophageal varices occur in about 40 percent of people who have cirrhosis.
  • Blood clot (thrombosis). A blood clot in the portal vein or in a vein that feeds into the portal vein called the splenic vein can cause esophageal varices.
  • A parasitic infection. Schistosomiasis is a parasitic infection found in parts of Africa, South America, the Caribbean, the Middle East and Southeast Asia. The parasite can damage the liver, as well as the lungs, intestine and bladder.
  • Budd-Chiari syndrome. This rare condition causes blood clots that can block the veins that carry blood out of your liver.

Although many people with advanced liver disease develop esophageal varices, most won't experience bleeding. Varices are more likely to bleed if you have:

  • 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 your 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 your liver disease, the more likely varices are to bleed.
  • Continued alcohol use. Your risk of variceal bleeding is far greater if you continue to drink than if you stop, especially if your disease is alcohol related.

Bleeding

The most serious complication of esophageal varices is bleeding. Once you have had a bleeding  episode, your risk of another bleeding episode is greatly increased. In some cases, blood loss is so great that you go into shock. This can lead to death.

Currently, no treatment can prevent the development of esophageal varices in people with cirrhosis. While beta blocker drugs are effective in preventing bleeding in many people who have esophageal varices, they do not keep esophageal varices from forming.

If you've been diagnosed with liver disease, ask your doctor about strategies to avoid liver disease complications. Some steps which may help keep your liver as healthy as possible include:

  • Don't drink alcohol. People with liver disease are often advised to stop drinking alcohol, since alcohol is processed by the liver. Drinking alcohol may stress an already vulnerable liver.
  • Eat a healthy diet. Choose a plant-based diet that's full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods you eat.
  • Maintain a healthy weight. An excess amount of body fat can damage your liver. Obesity is associated with a greater risk of complications of cirrhosis. Lose weight if you are obese or overweight.
  • Use chemicals sparingly and carefully. Follow the directions on household chemicals, such as cleaning supplies and insect sprays. If you work around chemicals, follow all safety precautions. Your liver removes toxins from your body, so give it a break by limiting the amount of toxins it must process.
  • Reduce your risk of hepatitis. Sharing needles and having unprotected sex can increase your risk of hepatitis B and C. Protect yourself by abstaining from sex or using a condom if you choose to have sex. Ask your doctor whether you should be vaccinated for hepatitis B and hepatitis A.
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