Living with oesophageal varices living

Overview

Oesophageal varices are swollen veins in the lower part of the food pipe (the tube that carries food from your throat to your stomach). They happen when blood flow through the liver is blocked, often because of liver damage. These veins are fragile and can burst, causing serious bleeding. With the right treatment and monitoring, the risk can be kept low.

Oesophageal varices are not common in the general population. They mostly affect people who have advanced liver disease, such as cirrhosis.

This condition usually appears in adults with long-term liver problems, including those caused by alcohol, viral hepatitis, or fatty liver disease. Children with liver disease can also develop varices.

Symptoms

Common symptoms

• No symptoms in the early stages; varices are often found during tests for liver disease.
• If they bleed, you may vomit blood or have black, tarry stools.
• You may feel weak, dizzy, or unusually tired if you are losing blood slowly.

Symptoms in children

• Children with liver disease may show the same signs of bleeding, such as vomiting blood or having dark stools.
• They may also seem paler than usual or become more tired than normal.

Symptoms in older adults

• Older adults may have a higher risk of bleeding because blood vessels become more fragile with age.
• They may experience dizziness, confusion, or falls due to blood loss.

Causes

Main causes

• Scarring of the liver (cirrhosis), which increases pressure in the portal vein — the main vein carrying blood from the gut to the liver.
• This higher pressure pushes blood into smaller veins in the food pipe, making them swell.
• Conditions that damage the liver, such as alcohol-related liver disease, hepatitis B or C, or fatty liver disease.

Risk factors

• A long history of heavy drinking.
• Chronic viral hepatitis (B or C).
• Non-alcoholic fatty liver disease (often linked to obesity or diabetes).
• Blockage or clot in the portal vein (less common).

When to see a doctor

See a doctor urgently if:

• If you vomit blood or have black or bloody stools, call your local emergency number straight away.

Book a routine appointment if:

• If you have liver disease or cirrhosis, keep all regular appointments and ask your doctor whether you need an endoscopy to check for varices.
• If you notice new or worsening symptoms like tiredness, swelling, or yellowing eyes, contact your doctor within a few days.

Diagnosis

Doctors use a small camera on a flexible tube (endoscopy) to look directly at the inside of your food pipe and see whether varices are present. The test is usually done with a light sedative and takes only about 15 minutes.

Tests that may be done

• Endoscopy — a thin tube with a camera passed through the mouth into the food pipe.
• Ultrasound or CT scan to look at your liver and blood flow.
• Blood tests to check liver function and how well your blood clots.

What to expect at your appointment

Your doctor will explain the procedure before it happens. You will be asked to not eat for a few hours. During the test, you will be relaxed and comfortable. If varices are found, your doctor will discuss a plan to lower the risk of bleeding.

Treatment

Treatment focuses on lowering the pressure in the veins, stopping any bleeding, and preventing future bleeds. You and your doctor will decide the best approach based on your overall health and the size of the varices.

Self-care at home

• Completely avoid alcohol, as it harms the liver further.
• Ask your doctor before taking any painkillers, supplements, or over-the-counter medicines — some can increase bleeding risk.
• Get vaccinated against hepatitis A and hepatitis B if your doctor recommends it.
• Keep your regular check-ups so any changes can be caught early.

Medical treatments

Your doctor may prescribe medicines that lower blood pressure in the veins. During an endoscopy, the doctor may use rubber bands to tie off the varices (called banding). This is a common and effective way to stop or prevent bleeding. Always take any prescribed medicines exactly as directed.

When is surgery considered?

If bleeding cannot be controlled or keeps coming back, doctors may suggest a procedure called TIPS, which creates a small connection between blood vessels to reduce pressure. In advanced liver disease, a liver transplant may be considered. These are major procedures, so your medical team will discuss the benefits and risks with you carefully.

Living with this condition

Living with oesophageal varices means taking good care of your liver and staying in touch with your healthcare team. With regular monitoring and by following your plan, most people can keep doing the activities they enjoy.

Lifestyle tips

• Avoid alcohol completely.
• Aim for a healthy weight and eat a balanced diet.
• Get regular, gentle exercise — ask your doctor what is safe for you.
• Tell every healthcare provider about your varices, including your dentist and pharmacist.
• Know the warning signs of bleeding and what to do in an emergency.

Diet and exercise

Eat a variety of fruits, vegetables, whole grains, and lean proteins. If you have had banding, avoid very rough or sharp foods for a little while to protect the food pipe. Light to moderate exercise is usually safe, but check with your doctor before starting a new routine.

Mental health and emotional wellbeing

Living with a liver condition can bring anxiety, fear, or low mood. These feelings are normal. Talk to your healthcare team about how you are coping, and ask about counselling or support groups — you do not have to carry this alone.

Prevention

You can reduce your risk of developing oesophageal varices by protecting your liver. The biggest step is to stop alcohol use, treat the underlying liver condition, and keep blood sugar and weight in a healthy range.

Vaccines

Ask your doctor about vaccines for hepatitis A and hepatitis B if you have liver disease. These infections can make liver damage worse.

Screening programmes

If you have cirrhosis, regular endoscopy can find varices early — before they bleed. Your doctor will tell you how often to have this test based on your condition.

Complications

If left untreated

• Bleeding from a ruptured varix, which can be life-threatening.
• Shock from rapid blood loss — with symptoms like low blood pressure, fast pulse, and confusion.
• Worsening liver disease, leading to liver failure over time.

Long-term outlook

The outlook is generally positive with the right care. Many people with oesophageal varices live for years without serious bleeding, because modern treatments are very effective. If bleeding does happen, emergency care can save lives. Staying close to your healthcare team and following your plan gives you the best chance at a stable, active life.

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