Gastric Varices

Overview

Gastric varices are swollen, stretched veins in the wall of your stomach. They usually happen because blood cannot flow normally through the liver. When that happens, blood backs up and looks for other routes to travel — a bit like traffic diverting down quiet side streets. Those 'side streets' are small veins around the stomach, and they swell up under the extra pressure. The main worry is that a swollen vein can leak or burst and cause serious bleeding inside the body. Many people with gastric varices never bleed, and treatment can lower that risk a great deal.

Gastric varices are much less common than varices in the food pipe. Among people who already have high pressure in the portal vein, roughly one in five has gastric varices. They are uncommon in people without liver or vein problems.

They mostly affect people with liver scarring (cirrhosis) from any cause, and people whose portal vein is blocked by a clot. Children can get them too, usually because of a liver problem or a vein problem they were born with. Some people get them from problems with the vein that drains the spleen, or from other conditions that raise pressure in the belly.

Symptoms

Common symptoms

• Often no symptoms at all — they may only be found on a routine scan or camera test
• Vomiting blood, which may look bright red or like coffee grounds
• Black, tar-like, smelly stools (this is digested blood)
• Feeling light-headed, dizzy or faint, especially on standing
• Feeling unusually tired, weak or short of breath (signs of low blood count from slow blood loss)
• Pale skin, a fast heartbeat, or cold, clammy hands
• A swollen, tight belly, or swelling in the legs
• Yellowing of the skin or eyes (jaundice) if liver problems are getting worse

Symptoms in children

• Vomiting blood or passing black stools
• Pale skin and low energy
• Poor growth or weight gain
• A larger-than-expected belly
• Yellow skin or eyes
• In many children there are no warning signs until bleeding starts

Symptoms in older adults

• Bleeding may show up first as tiredness, breathlessness or confusion rather than obvious blood loss
• Symptoms can be mistaken for other conditions, especially if there are several health problems at once
• Blood-thinning medicines can make any bleeding heavier, so tell your doctor about everything you take
• Older adults may need extra support to recover after a bleed

Causes

Main causes

• Liver scarring (cirrhosis) from any cause — this is the most common reason
• A blood clot in the portal vein, the large vein that carries blood from the gut to the liver
• A clot or blockage in the vein that drains the spleen, which can cause varices on their own
• Some long-term infections, such as certain parasitic infections that affect the liver
• Heart problems that raise pressure in the veins of the belly
• Rare inherited conditions that affect how blood clots or how veins develop

Risk factors

• Long-term heavy alcohol use
• Chronic hepatitis B or C infection
• Fatty liver disease linked to weight, diabetes or other metabolic problems
• Autoimmune or inherited liver conditions
• A previous bleed from varices, which raises the chance of another
• Medicines that make blood less likely to clot — these do not cause varices, but they can make bleeding worse
• Severe straining, coughing or heavy lifting can trigger a bleed in someone who already has varices

When to see a doctor

See a doctor urgently if:

• You vomit any blood, or your vomit looks like coffee grounds — call your local emergency number straight away
• You pass black tarry stools or red blood
• You feel faint, dizzy or your heart is racing
• You have a liver condition and suddenly feel much more confused or sleepy
• Your belly swells up quickly or becomes painful with a fever

Book a routine appointment if:

• You have been told you have liver scarring and want to know whether you should be checked for varices
• You have ongoing indigestion, fullness or discomfort in the upper belly
• You are starting a new medicine and want to check it is safe for your liver or bleeding risk
• You are planning travel and want advice on what to do if bleeding happens far from home

Diagnosis

The main test is an endoscopy — a thin, flexible tube with a tiny camera that is passed through your mouth so the doctor can look directly at the lining of your food pipe and stomach. This is usually done with sedation so you are comfortable. Your doctor will also want blood tests and scans to understand how well your liver is working and what is causing the pressure. Sometimes varices are first spotted on a scan done for another reason.

Tests that may be done

• Endoscopy (camera test) of the food pipe, stomach and upper gut — this is the key test
• Blood tests to check your blood count, liver and kidney function, and clotting
• Ultrasound of the liver and belly, often with a special dye-free Doppler setting to look at blood flow
• A liver stiffness scan (a painless vibration-based test) to estimate liver scarring
• CT or MRI scans to map the veins and plan treatment
• Tests to find the underlying cause, such as viral hepatitis tests

What to expect at your appointment

An endoscopy usually takes 15 to 30 minutes. You will be asked not to eat for several hours beforehand. You may be offered sedation, and your throat may be numbed with a spray. Most people find it uncomfortable rather than painful, and you will be watched for a short while afterwards. Your doctor will explain what was seen and agree a follow-up plan with you.

Treatment

Treatment has two aims: stopping a bleed if one happens, and lowering the chance of a first or repeat bleed. The right plan depends on the size and position of your varices, how well your liver is working, and your other health conditions. Your specialist team will talk you through the options.

Self-care at home

• Avoid alcohol completely if you have liver disease — this is one of the most powerful things you can do
• Check with your doctor or pharmacist before taking any painkiller, herbal remedy or supplement, as some can worsen bleeding or hurt the liver
• Tell every healthcare professional you see that you have gastric varices — including dentists and emergency staff
• Avoid heavy lifting and straining, and treat constipation early with advice from your team
• Keep a written plan of what to do and who to call if bleeding starts, and share it with people you live with
• Attend your monitoring appointments, even when you feel well

Medical treatments

Doctors can seal varices during an endoscopy by injecting a special glue-like material directly into the swollen vein — this is the most common approach for gastric varices and works well. Sometimes a doctor places a small band around a vein, though this is used more often for varices in the food pipe. You may also be offered medicines that lower the pressure inside the portal vein; these are taken long term and your doctor will explain the benefits and side effects. If bleeding is hard to control, specialist teams can place a small tube inside the liver to reroute blood flow (called a shunt), or use other procedures to block off the enlarged veins. You may also be given treatment to protect against infection during a bleed, and blood tests will be checked regularly.

When is surgery considered?

Surgery is not usually the first step. It may be considered when bleeding keeps coming back despite other treatments, when a shunt procedure is not suitable, or as part of an assessment for liver transplantation in people whose liver disease is advanced. These decisions are made by a specialist team and are always tailored to the individual.

Living with this condition

Most of living with gastric varices means keeping to your monitoring plan and knowing what to do if something changes. Keep your appointment dates, carry a short note or medical alert card saying you have varices, and make sure the people close to you know the emergency signs. If you travel, find out where the nearest hospital is before you go.

Lifestyle tips

• Stop drinking alcohol, or cut down as much as possible with support
• Keep to a healthy weight — your team can advise on safe ways to lose weight if needed
• Stay active in a way that suits you; gentle walking and light strength work are usually fine
• Avoid constipation by drinking enough fluid and eating fibre, and ask for help early if it becomes a problem
• Get vaccinated against hepatitis A and B if your doctor advises it
• Look after your general health — sleep, stress and other long-term conditions all affect how you feel

Diet and exercise

There is no special diet that cures varices, but a liver-friendly diet helps. That usually means plenty of vegetables and fruit, wholegrains, beans and pulses, and less salty and heavily processed food. If you have liver disease, your team may suggest a steady intake of protein and small, regular meals. Salt reduction matters if you get belly or leg swelling. Exercise should be something you enjoy and can keep up — walking, swimming, cycling or light weights. Build up slowly, and ask your doctor before starting anything strenuous if you have advanced liver disease.

Mental health and emotional wellbeing

Being told you have swollen veins that could bleed can cause real worry, and it is very common to feel anxious between appointments or to find yourself checking for symptoms. Some people feel low or isolated, especially if alcohol or liver disease has changed their life. These feelings are understandable and treatable — talking to your GP, a counsellor or a specialist liver nurse often helps a lot. If you ever feel you cannot cope or have thoughts of harming yourself, please reach out for crisis support in your country straight away — you deserve help and you do not have to manage alone.

Prevention

You cannot always prevent gastric varices, but you can greatly lower your risk by protecting your liver. Most varices are linked to liver scarring, so treating the underlying liver condition is the most important step. If you already have varices, the right monitoring and treatment can prevent bleeding.

Vaccines

Vaccines against hepatitis A and hepatitis B protect the liver from viral infection and are recommended for many people with liver disease. Ask your doctor or pharmacist whether they are right for you, and keep other routine vaccines up to date.

Screening programmes

If you have liver scarring, guidelines recommend a camera test of the food pipe and stomach at the time of diagnosis and then at intervals depending on what is found. If you have signs of high pressure in the portal vein, you may be offered medicine to lower the risk of bleeding even before varices are seen. Ask your specialist when your next check is due.

Complications

If left untreated

• A varice can burst and cause heavy bleeding into the stomach and gut
• Large blood loss can lead to shock, which is life-threatening without emergency care
• Slow, repeated bleeding can cause anaemia, with tiredness and breathlessness
• Bleeding raises the risk of infection, which can be serious in people with liver disease
• A bleed can make liver function worse for a while and may need hospital care
• There is a chance of bleeding coming back, which is why follow-up treatment matters

Long-term outlook

The outlook is much better than it used to be. Modern treatments can stop a bleed quickly, and planned treatment lowers the chance of bleeding in the first place. Many people live for years with varices and never have a serious bleed, especially when the underlying liver condition is looked after. Keeping to your follow-up plan and acting quickly on warning signs gives you the best possible outcome.

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