Bleeding Esophageal Varices

Bleeding esophageal varices occur when swollen veins (varices) in your lower esophagus, the muscular tube that connects your mouth with your stomach, rupture and bleed due to excess pressure. This condition constitutes an emergency and must be dealt with promptly.

Veins in the lower esophagus swell when blood flow to the liver is affected. The portal vein has the task of transporting blood from several organs of the gastrointestinal tract—including the stomach, small and large intestines, and spleen—to the liver. When pressure in the portal vein increases (a condition known as portal hypertension), blood starts to build up in the nearby blood vessels, including those of your esophagus, and cause the veins to dilate and swell.

Bleeding occurs because the veins of the esophagus have thin walls that aren’t capable of handling high pressure.

Esophageal varices are a direct result of portal hypertension, which is most commonly caused by liver cirrhosis. Cirrhosis is a condition involving scarring of the liver that is caused by infections such as hepatitis or excessive alcohol consumption. Other causes of portal hypertension include:

• portal vein thrombosis (blood clots inside the portal vein)
• portal vein obstruction
• idiopathic portal hypertension (unknown cause)

The risk factors for bleeding esophageal varices include:

• size of the varices—the larger they are, the more easily they can rupture
• red color signs—during an endoscopic examination, the varices may reveal red markings or spots
• high portal vein pressure
• severe cirrhosis
• continued alcohol use—consuming alcohol despite pre-existing liver problems
• bacterial infection

Esophageal varices are unlikely to display symptoms unless they have ruptured, in which case you may experience:

• hematemesis (blood in vomit)
• abdominal pain
• lightheadedness
• melena (black stools)
• bloody stools (only in severe cases)
• shock (only in severe cases, due to blood loss)

If you have a history of liver disease, you may consider consulting your physician about your risk of developing esophageal varices.

The following tests may be used to diagnose esophageal varices:

• blood test
• endoscopy (insertion of a thin tube with a camera down the throat to examine it for esophageal varices)
• computed tomography (CT) scan
• magnetic resonance imaging (MRI)

The main purpose of treatment for esophageal varices is to prevent them from rupturing.

Controlling Portal Hypertension

Controlling portal hypertension is usually the first step to diminish the risk for bleeding. This may be achieved through the use of the following:

• Beta Blockers: Your doctor may prescribe beta blocker medications, such as propranolol, to lower your blood pressure.
• Endoscopic Sclerotherapy: With the help of an endoscope, your physician will inject a medication into your varices that will make them shrink.
• Endoscopic Variceal Ligation (Banding): Your physician will use an endoscope to tie off the veins of your esophagus with an elastic band.

If Bleeding Has Begun

Endoscopic variceal ligation or endoscopic sclerotherapy are preventive treatments, but your doctor may also use them if bleeding has begun. The drug octreotide (Sandostatin) may be used to lower the pressure in the portal vein by inhibiting the blood flow from organs that drain into it.

Another potential treatment option is a transjugular intrahepatic portosystemic shunt (TIPS). For this treatment, a small tube is used to connect the portal vein with the hepatic vein, which is the vein that transports blood from the liver toward the heart. This connection creates a diversion for the blood flow.

In some cases, a liver transplant may be necessary.

Bleeding reoccurs if the varices are not treated properly. You must have regular consultations with your physician to ensure the success of the treatment. Without treatment, this condition may be fatal.

The best way to prevent esophageal varices is to correct the underlying cause. If you have liver disease, you may want to consider the following preventive measures to reduce your risk of developing esophageal varices:

• Maintain a healthy diet.
• Stop drinking alcohol.
• Keep an eye on your weight.
• Be careful not to get hepatitis.