Oesophageal varices awareness

Overview

Oesophageal varices are swollen veins in the tube that connects your throat to your stomach (the oesophagus). They happen when blood flow through the liver is blocked, often because of liver damage. These veins can burst and bleed, which is a medical emergency.

Oesophageal varices are not common in the general population. They mainly affect people with advanced liver disease, such as cirrhosis (scarring of the liver).

Oesophageal varices can affect anyone with chronic liver disease, including those with cirrhosis from alcohol use, hepatitis B or C, fatty liver disease, or other causes. Men and people over 50 are more likely to have them.

Symptoms

Common symptoms

• Most people with oesophageal varices have no symptoms until they bleed.
• If varices are large, you may feel mild discomfort behind the breastbone or have difficulty swallowing.

Symptoms in children

• Children with oesophageal varices may have no symptoms or may vomit blood or have black, tarry stools.

Symptoms in older adults

• Older adults may have symptoms like feeling dizzy, weak, or confused if varices are bleeding. They are at higher risk for severe bleeding.

Causes

Main causes

• The most common cause is cirrhosis (scarring of the liver) which blocks blood flow through the liver, causing pressure to build up in the veins that carry blood to the liver.

Risk factors

• Heavy, long-term alcohol use
• Chronic viral hepatitis (B or C)
• Non-alcoholic fatty liver disease (often linked to obesity and diabetes)
• Autoimmune liver diseases like primary biliary cholangitis
• Blocked blood vessels inside the liver (portal vein thrombosis)

When to see a doctor

See a doctor urgently if:

• If you have any sign of bleeding from oesophageal varices (vomiting blood, black stools, feeling faint) — call your local emergency number immediately.
• If you have been diagnosed with liver disease and suddenly feel very unwell, weak, or confused.

Book a routine appointment if:

• If you have known liver disease and have not been checked for varices, ask your doctor about a screening endoscopy.
• If you have symptoms like trouble swallowing or pain behind the breastbone that does not go away.

Diagnosis

Oesophageal varices are usually found during a test called an upper endoscopy (or gastroscopy). A thin, flexible tube with a camera is passed through your mouth into your oesophagus and stomach to look for swollen veins.

Tests that may be done

• Upper endoscopy (gastroscopy) – the main test to see varices and check their size.
• Imaging tests like ultrasound, CT scan, or MRI to check blood flow and liver health.
• Blood tests to measure liver function, clotting, and signs of liver damage.

What to expect at your appointment

If you have an endoscopy for varices, you will be given a sedative to help you relax. The test takes about 15–30 minutes. Afterward, you may have a sore throat but can go home the same day. Your doctor will tell you the results and whether you need treatment.

Treatment

Treatment aims to prevent bleeding or stop active bleeding if it occurs. It also focuses on managing the underlying liver disease. Your care team will create a plan based on your varices and overall health.

Self-care at home

• Stop drinking alcohol completely – this is the most important step for people with alcohol-related liver disease.
• Follow a balanced diet and keep a healthy weight.
• Take prescribed medicines exactly as advised.
• Attend all follow-up appointments and tests.

Medical treatments

Doctors may use medicines to reduce the pressure in the veins (beta-blockers) or perform procedures during endoscopy, such as banding (placing small rubber bands around the varices to remove them). If bleeding occurs, you may need an urgent procedure, such as a special tube inserted to stop the blood loss.

When is surgery considered?

In rare cases, if other treatments do not work, a procedure called transjugular intrahepatic portosystemic shunt (TIPS) may be used to create a new pathway for blood flow. Occasionally, a liver transplant may be needed for severe liver disease.

Living with this condition

Living with oesophageal varices means regularly managing your liver condition. You will need to have follow-up endoscopies to check for new or growing varices. Avoid anything that can irritate the oesophagus, like very hot drinks or rough foods.

Lifestyle tips

• Do not drink alcohol – ask your doctor for support if you need help stopping.
• Do not smoke.
• Avoid medicines like aspirin or ibuprofen unless your doctor says it is safe, because they can increase bleeding risk.
• Stay in close contact with your liver specialist.

Diet and exercise

Eat a well-balanced diet with plenty of vegetables, fruits, and lean protein. Avoid fried or heavily processed foods. Gentle exercise like walking is fine, but avoid heavy lifting or straining, as that can increase pressure in the veins.

Mental health and emotional wellbeing

Having a serious health condition can cause anxiety, stress, or depression. It is normal to feel worried. Talking to a counsellor, joining a support group, or simply sharing your feelings with family can help. Your healthcare team can also guide you to resources.

Prevention

You can reduce your risk of developing oesophageal varices by preventing or managing liver disease. This includes limiting alcohol, getting vaccinated against hepatitis B, avoiding needle sharing, and maintaining a healthy weight and diet.

Vaccines

Hepatitis B vaccination is recommended for people at risk of liver disease. There is no vaccine for hepatitis C, but it can be treated.

Screening programmes

If you have cirrhosis or advanced liver disease, your doctor will recommend regular endoscopy every 1–2 years to check for varices. This helps catch them before they bleed.

Complications

If left untreated

• Bleeding from oesophageal varices can lead to severe blood loss, shock, and death if not treated quickly.
• Repeated bleeding can damage the liver further and lead to liver failure.
• Infections, kidney problems, and other organ damage can occur after a major bleed.

Long-term outlook

With proper management and regular monitoring, many people with oesophageal varices can avoid bleeding and live well for many years. Early detection and treatment of the underlying liver disease are very important. If bleeding does happen, modern medical treatments are very effective at stopping it, and emergency care can save lives.

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