Varices are large or swollen blood vessels, which can be located around the esophagus. The most common cause of esophageal varices is scarring of the liver.
Varices may be small or large, and the bigger they are, the more serious they become.
The vessels can rupture, in which case treatment focuses on preventing bleeding by closing the vessels. Doctors may also recommend medication to reduce blood pressure.
In this article, we describe the types and causes of esophageal varices, as well as the treatment options available.
The veins in the esophagus connect to the liver. These veins can become swollen when there is an obstruction in the flow of blood to the liver. This obstruction causes blood to collect in connecting vessels, including those in the esophagus.
As the esophageal veins are small and have thin walls, they cannot contain large amounts of blood. Therefore, the increase in blood flow can cause the veins to swell and rupture.
A rupture can be dangerous and even fatal. Anyone who suspects that they have a bleeding esophageal varice should receive immediate medical attention.
Cirrhosis is severe scarring of the liver caused by a disease, such as hepatitis C. It is the most common underlying cause of esophageal varices.
Portal hypertension is a complication of cirrhosis. It happens when scar tissue blocks the flow of blood around the liver. This leads to high blood pressure in the portal vein, which carries blood from other organs to the liver.
If blood flow around the liver is restricted, the body sends blood via veins in the stomach or esophagus instead. With more blood flowing through them, these veins can swell, becoming varices.
Budd-Chiari syndrome causes veins in the liver to become partially blocked. Schistosomiasis is a disease caused by parasitic worms. These can get into the blood vessels, which may cause them to become varices.
A person with esophageal varices may not have symptoms, particularly if the varices are small. Some people only experience symptoms if the varices bleed.
Symptoms of esophageal varices may include:
- unusually pale skin
- ongoing tiredness
- shortness of breath
- faintness or dizziness
- black or tarry stools
- dark or bright red blood in stool
- bright red blood in vomit
If a person experiences these symptoms, they should receive care in a hospital immediately.
Any liver disease can increase a person’s risk of developing esophageal varices, but cirrhosis is the most common cause. A person with liver disease but no cirrhosis has a lower risk of varices.
Cirrhosis and portal hypertension are the most common causes of esophageal varices. These are both possible complications of liver disease.
The main risk factors for liver disease include:
- hepatitis infection
- alcohol misuse
When diagnosing liver disease, a doctor will have considered:
- the person’s symptoms
- their medical history
- results of blood tests, a physical examination, and sometimes a liver biopsy
Esophageal varices can be small or large. Small varices measure less than 5 millimeters in diameter, and they may require different treatments from larger varices.
Small varices do not always cause symptoms. A doctor will recommend ways to prevent further liver damage, which may involve medication and lifestyle changes.
Treatment for large varices may involve minor surgery to prevent bleeding.
Varices can also form in other areas of the body: Gastric varices occur in the stomach and duodenal varices form in the first part of the small intestine. A person can also develop rectal varices.
The main goal of treatment for esophageal varices is to prevent ruptures and bleeding. Initially, this often involves steps to control portal hypertension.
The doctor may prescribe beta-blockers to reduce blood pressure. These drugs work by blocking the effects of a hormone called epinephrine, making the heart beat slower and with less force.
A person with esophageal varices may also require one of the following surgical procedures.
Endoscopic sclerotherapy involves using an endoscope to perform minor medical tasks, such as injecting a medication into the swollen veins to make them shrink.
Endoscopic variceal banding involves using the same tool to place a rubber band around a varice to prevent the vessel from bleeding.
Additional treatments may be necessary for varices that bleed recurrently.
A doctor may recommend a transjugular intrahepatic portosystemic shunt, or TIPS, procedure. This involves using an X-ray to guide the placement of a small tube to connect the portal vein with the hepatic vein. This creates a new channel for blood, reducing pressure in the portal vein.
Another treatment option is a distal splenorenal shunt procedure. This connects the main vein of the spleen to the vein of the left kidney.
It is not always possible to prevent esophageal varices. Still, anyone with cirrhosis should receive treatment to reduce the risk of complications such as varices.
Also, medication and lifestyle changes can help reduce further liver damage and, thus, the risk of developing varices.
If a person has varices, beta-blockers can help prevent them from bleeding. Banding can also help keep varices closed. Avoiding any ruptures is key to preventing complications.
Esophageal varices are large or swollen blood vessels around the esophagus. If they rupture and the blood leaks, it can cause serious complications.
Esophageal varices usually result from cirrhosis and portal hypertension.
If the varices are small, a person may be able to prevent further damage by making lifestyle changes and taking medication.
If they are large, the person may need to undergo one or more minor surgical procedures.