Esophageal varices

Overview

Esophageal varices are swollen veins found in the esophagus, the tube linking the throat and stomach. They typically occur in individuals with serious liver diseases. These varices develop when regular blood flow to the liver is blocked, often due to liver scarring or blood clots. In response, blood diverts into smaller vessels ill-suited for high blood volumes, leading to potential blood leaks or ruptures, which can be life-threatening.

Symptoms of esophageal varices include weakened vein walls that may rupture, causing sudden and severe internal bleeding. This condition primarily affects people with portal hypertension, characterized by elevated blood pressure in the liver’s portal vein and its associated branches. This increased pressure leads to the enlargement of the delicate esophageal veins, especially common in individuals with liver disorders.

Treatment for esophageal varices aims to prevent or stop bleeding. Medical procedures and medications are available to address the underlying causes and reduce the risk of life-threatening bleeding episodes.

Symptoms

Esophageal varices typically remain asymptomatic until they start bleeding. Signs of bleeding esophageal varices include:

• Vomiting blood in large quantities.
• Passing black, tarry, or bloody stools.
• Feeling lightheaded due to blood loss.
• Loss of consciousness in severe cases.

A healthcare provider may suspect esophageal varices if they observe other signs indicating portal hypertension or chronic liver disease, such as:

• Jaundice (yellowing of the skin and eyes).
• Ascites (accumulation of fluid in the abdomen).
• Swollen legs and feet (edema).
• Upper abdominal discomfort (soreness of the liver or spleen).
• Itching (pruritus) without visible rash.
• Confusion or disorientation (hepatic encephalopathy).

If you are experiencing worrisome symptoms or have been diagnosed with liver disease, consult your healthcare provider to discuss your risk of esophageal varices and preventive measures. They may also recommend a procedure to check for the presence of esophageal varices.

If you experience severe blood loss and signs of hypovolemic shock, seek immediate emergency medical care. Signs of hypovolemic shock include:

• Rapid heart rate.
• Fast breathing.
• Cold, clammy skin.
• Sweating.
• Anxiety and confusion.
• Loss of consciousness.

Causes

Esophageal varices can develop when the flow of blood to your liver is blocked, mainly due to liver disease, or cirrhosis. This condition is called portal hypertension, which happens when the blood starts piling up in the portal vein that carries blood to your liver.

As a result of this increased pressure, the blood tries to find alternative paths through smaller veins, particularly in the lower part of the esophagus. These smaller veins are not as sturdy, and they can expand and sometimes burst, causing bleeding.

There are a few main causes of esophageal varices:

• Liver cirrhosis: Extensive scarring of the liver, which can be caused by various liver diseases like hepatitis, alcoholic liver disease, fatty liver disease, and primary biliary cholangitis.
• Blood clots: Clots forming in either the portal vein or a vein connected to it, like the splenic vein, can lead to esophageal varices.
• Parasitic infections: In some area like parts of Africa, South America, the Caribbean, the Middle East, and East Asia, a parasitic infection called schistosomiasis can harm the liver and contribute to esophageal varices. This infection can also affect other organs like the lungs, intestines, and bladder.

Risk factors

Most cases of esophageal varices will not bleed. People who experience bleeding before are at a higher risk of experiencing it again. Generally, the risk of bleeding may increase due to several factors, such as:

• Elevated portal vein pressure: Pressure builds up steadily until a rupture happens. Although there is often no specific triggering event, variceal rupture typically happens when the blood pressure in the vein increases by 50% to 100%.
• Large varices: Varices prone to bleeding are typically larger than 5 millimeters in size. The likelihood that esophageal varices will bleed increases with size.
• Varices with red markings: There is a significant risk of bleeding among esophageal varices that reveals long, red streaks or red patches.
• Severe liver failure or cirrhosis: Esophageal variceal bleeding is more probable in cases of advanced liver disease.
• Consistent alcohol drinking: If the liver disease is linked to alcohol, the likelihood of experiencing variceal bleeding significantly increases if one persists in alcohol consumption.