Bleeding esophageal varices


Definition

The esophagus is the tube that connects your throat to your stomach. Varices are enlarged veins that may be found in the esophagus. These veins may break open and bleed.

Alternative Names

Liver cirrhosis - varices; Cryptogenic chronic liver disease - varices; End-stage liver disease - varices; Alcoholic liver disease - varices

Causes

This EM Should be displayed at the top of the article section "Causes"

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 break open.

Any type of chronic liver disease can cause esophageal varices.

Varices can also occur in the upper part of the stomach.

Symptoms

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 determine if there is active bleeding include:

Some providers recommend 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.

Treatment

The goal of treatment is to stop acute bleeding as soon as possible. Bleeding must be controlled quickly to prevent shock and death.

If massive bleeding occurs, a person may need to be put on a ventilator to protect the airways 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, including:

Emergency surgery may be used (rarely) to treat people if other therapy fails. Portocaval shunts or surgery to remove the esophagus are 2 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.

Outlook (Prognosis)

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 result in a decrease of blood supply to the brain, leading to mental status changes.

Possible Complications

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.

Prevention

Treating the causes of liver disease may prevent bleeding. Liver transplantation should be considered for some people.

References

Garcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 153.

Savides TJ, Jensen DM. Gastrointestinal bleeding. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 20.

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