Esophageal varices are enlarged veins at the lower end of the esophagus (the tube that carries food from the mouth to the stomach). Varices most often occur because of problems with blood flow in the liver that are caused by chronic liver disease. Normally, a blood vessel called the portal vein carries blood from the digestive organs to the liver. But with liver disease, blood flow can become blocked because of scarring of the liver. This increases the blood pressure in the portal vein (a condition known as portal hypertension). Blood then backs up in nearby veins in the esophagus and stomach, causing varices. Varices are a serious and life-threatening problem. Treatment is needed to prevent them from rupturing and bleeding. If bleeding occurs, it can be fatal.
Symptoms of Esophageal Varices
Symptoms do not occur unless the varices are bleeding. This is an emergency problem. If you have any of the following symptoms, get medical attention right away:
Black, tarry, or bloody stools
Lightheadedness or loss of consciousness (fainting)
Diagnosing Esophageal Varices
You’ll likely be checked for varices if you have liver disease or other health problems that can cause them. The doctor will ask about your symptoms and health history. You’ll also be examined. Tests are then done to confirm the problem. These can include:
Upper endoscopy. This is done to see inside the upper digestive tract. During the test, an endoscope is used. This is a thin, flexible tube with a tiny camera on the end. It’s inserted through the mouth. It’s then guided down through the esophagus, stomach, and first part of the small intestine. This allows the doctor to check for varices and detect any bleeding.
Imaging tests. These provide pictures of the liver or blood flow in the liver. They allow the doctor to check for enlarged veins around the liver and assess the risk of bleeding. Common imaging tests done include ultrasound and computed tomography (CT) scans.
Treating Esophageal Varices
The goal of treatment is to reduce the risk of bleeding or to control bleeding. Treatment can include one or more of the following:
Medications. These may be prescribed to lower the blood pressure inside the enlarged veins. This reduces the risk of bleeding. Beta-blockers are the most common medication used.
Endoscopic therapy. These are treatments for enlarged or bleeding veins that are done with the help of an endoscope. With ligation, small rubber bands are placed around the veins to close them off and stop any bleeding. With sclerotherapy, clotting medication is injected into the veins to cause scarring and shrink them.
Balloon tamponade. This is a procedure in which a tube with a balloon is guided down into the esophagus and stomach. The balloon is then inflated with air. This applies pressure on enlarged or bleeding veins to control bleeding. This is a temporary method to control bleeding until other treatments are available.
Surgery. This may be done to place a stent (tubelike device) in the liver. The stent helps reroute blood flow in the liver to lower the blood pressure in enlarged veins. Sometimes, the enlarged veins may be connected to other nearby veins to reroute blood flow. In severe cases, a liver transplant may be needed. This is to replace the diseased liver with a healthy donor liver.
Regular visits with the doctor are needed to check for bleeding of the varices. If bleeding occurs, it is likely to occur again. More treatments will then be needed in the future. Once endoscopic therapy (banding) is performed, regular follow up endoscopic scans with banding are done to completely eradicate the varices. Work closely with your doctor to manage your condition and know when to seek emergency care.