Oesophageal varices living

Overview

Oesophageal varices are swollen, enlarged veins in the tube that connects your throat to your stomach (the oesophagus). These veins become stretched and can sometimes burst, causing serious bleeding. The condition usually develops in people with advanced liver disease because the liver cannot handle blood flow normally, so blood seeks other pathways, putting pressure on the veins in the oesophagus.

Oesophageal varices are not common in the general population. They usually appear in people with advanced liver disease, such as cirrhosis. Among people with cirrhosis, roughly half will develop varices at some point.

Oesophageal varices mostly affect adults with long-term liver disease, especially those with cirrhosis. Men are slightly more likely to develop them than women. They are rare in children, but can occur if a child has a liver condition.

Symptoms

Common symptoms

• Most people with oesophageal varices have no symptoms at all until they bleed.
• If varices bleed, symptoms can include vomiting blood (which may look red or like coffee grounds), black or tarry stools, feeling dizzy or light-headed, and a fast heartbeat.

Symptoms in children

• In children, the symptoms are similar to adults and may include vomiting blood or passing dark poo.
• Some children with liver disease may also show signs such as poor appetite or tiredness.

Symptoms in older adults

• In older adults, bleeding can cause confusion, a drop in blood pressure, and falls.
• It may be difficult to tell if symptoms are due to the varices or another health problem, so it is important to seek medical advice quickly.

Causes

Main causes

• Advanced liver disease (cirrhosis) is the main cause of oesophageal varices.
• Damage from alcohol-related liver disease, viral hepatitis (B or C), or fatty liver disease can lead to cirrhosis.
• High blood pressure in the portal vein (the large vein that carries blood from the gut to the liver) forces blood to flow through smaller veins, including those in the oesophagus, causing them to swell.

Risk factors

• Heavy alcohol use over many years
• Obesity and metabolic syndrome
• Viral hepatitis infection
• A family history of liver disease

When to see a doctor

See a doctor urgently if:

• If you have cirrhosis or liver disease and you notice blood in your vomit or stools, you need immediate medical attention. Call your local emergency number.
• If you have a sudden change in your consciousness, feel faint, or have a very fast heartbeat, seek urgent care.

Book a routine appointment if:

• If you have been diagnosed with liver disease, keep all appointments with your liver specialist even if you feel well. They may recommend regular checks for varices.
• If you have new or mild symptoms like a full feeling in your belly, weight loss, or ongoing tiredness, tell your doctor.

Diagnosis

A doctor will review your medical history, do a physical exam, and may order blood tests and imaging. The most common way to confirm oesophageal varices is with an endoscopy, in which a thin, flexible tube with a camera is passed through your mouth into your oesophagus. This allows the doctor to see the veins directly.

Tests that may be done

• Blood tests to check liver function and blood cell counts
• Ultrasound or CT scan of your liver and abdomen
• Endoscopy (a camera test) to look at the oesophagus
• FibroScan, a special ultrasound test that measures liver stiffness

What to expect at your appointment

An endoscopy usually takes about 15 to 20 minutes. You will be given medication to help you relax, and you may be asleep. You can go home the same day. The results will help your doctor decide if you need treatment to reduce the risk of bleeding.

Treatment

Treatment aims to prevent bleeding and manage the underlying liver condition. If you have varices that have not bled, your doctor may suggest regular monitoring and medicines to lower blood pressure in the portal vein. If you have had bleeding, you will need urgent treatment to stop the bleeding and prevent future episodes.

Self-care at home

• Take all medicines exactly as prescribed, even if you feel well.
• Avoid alcohol completely, as it can damage the liver further.
• Eat a balanced diet low in salt to reduce fluid buildup, and keep a healthy weight.

Medical treatments

Your doctor may recommend medicines that lower blood pressure in the blood vessels of the liver to reduce the risk of bleeding. Other treatments include endoscopic band ligation, where small rubber bands are placed around the varices to tie them off, and a procedure called transjugular intrahepatic portosystemic shunt (TIPS) that helps redirect blood flow if bleeding continues. Your healthcare team will explain the options and what is best for you.

When is surgery considered?

If you have severe bleeding that does not stop with other treatments, a procedure called TIPS or, in very rare cases, a liver transplant may be considered. These are major treatments, so your doctor will discuss them with you in detail.

Living with this condition

Living with oesophageal varices involves regular medical care and making small daily changes. Attend all appointments, take your medicines, and know the warning signs of bleeding so you can get help quickly. It can be stressful, but many people manage well with support.

Lifestyle tips

• Quit alcohol and avoid recreational drugs
• Maintain a healthy weight through a balanced diet and gentle activity
• Avoid heavy lifting or straining, which can raise pressure in your veins
• Get vaccinated against hepatitis A and B to protect your liver if your doctor recommends

Diet and exercise

Eat a varied diet rich in fruits, vegetables, wholegrains, and lean protein. Reduce salt to help prevent fluid retention. Gentle exercises like walking or swimming are good, but avoid heavy lifting and contact sports. Always check with your doctor before starting new exercise.

Mental health and emotional wellbeing

Being diagnosed with a liver condition and the risk of bleeding can feel overwhelming. It is normal to feel anxious or low. Talk to your healthcare team about your feelings. Many people benefit from counselling or support groups. Remember, taking care of your mental health is part of taking care of your liver. If you are thinking about self-harm or feel you cannot cope, reach out to a mental health crisis service or go to your nearest emergency department.

Prevention

You can reduce your risk of developing oesophageal varices by looking after your liver. The most important steps are to avoid alcohol, maintain a healthy weight, and manage conditions like diabetes and high cholesterol. If you have a liver condition, follow your doctor's advice and keep up with checks.

Vaccines

Ask your doctor about vaccines for hepatitis A and B, as these infections can harm your liver further.

Screening programmes

If you have cirrhosis, your doctor may recommend an endoscopy to screen for varices. This can catch them before they bleed, so treatment can be started early.

Complications

If left untreated

• The most dangerous complication is sudden bleeding from the varices, which can be life-threatening.
• Bleeding can lead to a drop in blood pressure, shock, and anaemia.
• You may develop ascites (fluid in the belly) or hepatic encephalopathy (confusion due to poor liver function) as part of advanced liver disease.

Long-term outlook

With good medical care, many people with oesophageal varices live well for a long time. Treatment can greatly reduce the chance of bleeding, and support from your healthcare team can help you manage your liver condition. It is natural to worry, but you do not have to face this alone. There are effective options, and talking openly with your doctor can help you feel more in control.

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