15429 Esophageal Varices

Overview

Esophageal varices are abnormally swollen veins in the walls of the esophagus, the tube that carries food from your throat to your stomach. They develop when blood cannot easily flow through the liver, often because of liver disease, and pressure builds up in nearby veins.

It is not a common condition in the general population. It mainly affects people with serious liver disease, such as cirrhosis.

Esophageal varices affect people of all ages who have chronic liver disease. Adults are most often affected, especially those who drink large amounts of alcohol or who have fatty liver disease, hepatitis B, or hepatitis C.

Symptoms

Common symptoms

• Many people have no symptoms at all.
• If symptoms occur, they are usually signs of bleeding, such as vomiting blood or passing dark stools.

Symptoms in children

• Esophageal varices are rare in children, but if they occur, symptoms are similar to adults—including vomiting blood or dark stools. Liver disease in children can be due to inherited conditions or other causes.

Symptoms in older adults

• Older adults may have the same symptoms, but they may also experience confusion, fainting, or falls due to blood loss. Other health conditions can make symptoms less obvious.

Causes

Main causes

• Scarring of the liver (cirrhosis) that blocks normal blood flow and raises pressure in the portal vein.
• Blood clots in the portal vein (less common).
• Rarely, other conditions that increase pressure in the portal vein, such as heart failure or parasitic infections.

Risk factors

• Chronic heavy drinking (alcohol-related liver disease)
• Chronic hepatitis B or C infection
• Non-alcoholic fatty liver disease
• Cirrhosis from any cause
• A family history of liver conditions (rare)

When to see a doctor

See a doctor urgently if:

• Call your local emergency number immediately if you vomit blood, pass black or bloody stools, or feel faint.

Book a routine appointment if:

• If you have liver disease or a history of cirrhosis, ask your doctor about being checked for varices, even if you feel fine.

Diagnosis

Esophageal varices are usually found during a test called an upper endoscopy. This is a procedure where a thin, flexible tube with a camera is passed down your throat to see the inside of your esophagus and stomach.

Tests that may be done

• Upper endoscopy (also called gastroscopy)
• Imaging tests such as ultrasound, CT scan, or MRI to check blood flow in the liver
• Blood tests to check liver function and signs of liver damage

What to expect at your appointment

The procedure is usually done after you are given medicine to make you sleepy. You will not feel pain. If varices are seen, your doctor can often treat them during the same procedure to help prevent bleeding.

Treatment

The main goal of treatment is to lower the pressure in the varices and prevent serious bleeding. Your doctor will also focus on treating the underlying liver condition.

Self-care at home

• Do not drink alcohol. This can make liver disease worse and increase the risk of bleeding.
• Follow a well-balanced diet, and ask your doctor if you need to limit salt.
• Avoid heavy lifting, straining during bowel movements, and vigorous exercise, as these can raise pressure in your veins.
• Always check with your doctor before taking any new medicine, including over-the-counter painkillers, as some can harm the liver.
• Keep all your follow-up appointments.

Medical treatments

Doctors use several approaches to treat or prevent variceal bleeding. These include medicines that reduce blood pressure in the portal vein, and endoscopic treatments where the swollen veins are either tied off with rubber bands or shrunk with a special injection. In some cases, a small device called a stent may be placed to reroute blood flow. Your doctor will explain which option is best for your situation.

When is surgery considered?

Surgery is rarely needed. A liver transplant may be considered if you have severe liver failure and other treatments are not working.

Living with this condition

Living with esophageal varices means taking good care of your liver and being aware of warning signs. Keep regular appointments, take all prescribed medicines as directed, and tell your doctor about any new symptom right away.

Lifestyle tips

• Avoid alcohol completely.
• Quit smoking, as it can worsen liver disease.
• Maintain a healthy weight.
• Do not use recreational drugs.
• Talk to your doctor before using herbal supplements, as some can be harmful to the liver.

Diet and exercise

Eat a healthy diet that includes plenty of vegetables, fruits, whole grains, and lean protein. Ask your doctor about your salt and protein needs, especially if your liver disease is advanced. Light exercise such as walking is usually fine, but avoid heavy lifting or contact sports.

Mental health and emotional wellbeing

Being diagnosed with a condition that can lead to bleeding can be stressful and frightening. You may feel anxious or down. This is normal. Talking with a counselor, joining a support group, or reaching out to trusted friends and family can make a big difference. If you or someone you know is in emotional crisis, contact a local crisis hotline or speak to your doctor immediately.

Prevention

Not always, but you can lower your risk by preventing liver disease. This includes moderating or avoiding alcohol, getting vaccinated against hepatitis B, being tested and treated for hepatitis C, and keeping a healthy weight.

Vaccines

You can protect yourself from hepatitis B with a safe and effective vaccine. Depending on your liver health, your doctor may also recommend the hepatitis A vaccine.

Screening programmes

If you have cirrhosis or advanced liver disease, your doctor may suggest regular upper endoscopies to look for varices and treat them early if needed.

Complications

If left untreated

• Bleeding from a ruptured varice can cause massive blood loss, leading to shock.
• Severe bleeding can be life-threatening and requires emergency medical care.
• Repeated bleeding can worsen liver damage.
• Other complications of liver disease, such as fluid buildup in the belly or confusion, may also occur.

Long-term outlook

The outlook is better than it used to be. With good medical care, many people with esophageal varices avoid bleeding and lead active lives. The most important steps are to keep your liver as healthy as possible, take your medicines as prescribed, and get immediate help if any warning sign appears.

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