Description

Esophageal varices are dilated veins in the esophagus, the tube that connects the throat and the stomach. Esophageal varices most commonly occur in people with serious liver diseases.

Esophageal varices a regular basis when the blood flow to the liver is blocked by a clot or scar tissue in the liver. To go around the blockages, blood flow in the smallest blood vessels that are not designed to transport large volumes of blood. The blood vessels can leak blood or even rupture and cause life-threatening bleeding.

A couple of medicines and medical procedures are available to help prevent or stop bleeding from esophageal varices.

Symptoms

Esophageal varices usually do not cause symptoms unless they bleed. The symptoms of bleeding esophageal varices are:

  • Vomiting large amounts of blood.
  • Black, tarry stools, or blood in the stool.
  • Feeling dizzy due to the blood loss.
  • The loss of consciousness in severe cases.

A health professional may suspect esophageal varices if someone has signs of liver disease or have been diagnosed with cirrhosis of the liver, including:

  • Yellowing of skin and eyes, known as jaundice.
  • Easy bruising or bleeding.
  • The accumulation of fluid in the abdomen, called ascites (uh-SAHY-teez).

When to see a doctor

Make an appointment with a health care professional if you have symptoms that concern you. If you have been diagnosed with liver disease, consult a health professional about the risk of esophageal varices and what you can do to reduce your risk. Also ask if you should get a procedure to check for esophageal varices.

If you have been diagnosed with esophageal varices, a care professional will probably tell you to watch for signs of bleeding. Bleeding from esophageal varices are an emergency. Call 911 or your local emergency services right away if you have black or bloody stools, or blood in the vomit.

Causes

Esophageal varices are sometimes formed when the blood flow to the liver is blocked. This is most often caused by scar tissue in the liver due to liver disease, also known as cirrhosis of the liver. The flow of the blood begins to accumulate. This increases the pressure within the large vein, known as the portal vein, which carries blood to the liver. This is known as portal hypertension.

Portal hypertension forces the blood to seek other ways through the smaller veins, such as those in the lower part of the esophagus. These thin-walled veins balloon with the addition of the blood. Sometimes crack and bleed.

Causes of esophageal varices are:

  • Severe scarring of the liver, called cirrhosis. Several diseases of the liver, including hepatitis c infection, alcoholic liver disease, fatty liver disease and bile duct disorder called primary biliary cholangitis — can result in cirrhosis.
  • A blood clot, also called a thrombosis. A blood clot in the portal vein or into a vein that feeds into the portal vein, known as the splenic vein, can cause esophageal varices.
  • The parasitic infection. Schistosomiasis is a parasitic infection found in parts of Africa, South America, the Caribbean, the Middle East and East Asia. The parasite can damage the liver, as well as the lungs, the intestine, the bladder and other organs.

Risk factors

Although many people with advanced liver disease develop esophageal varices, most do not have bleeding. Esophageal varices are more likely to bleed if you have:

  • High pressure in the portal vein. The risk of bleeding increases as the pressure in the portal vein increases.
  • Large varices. The largest of the esophageal varices, the more are the chances of bleeding.
  • Red marks on the varices. Some esophageal varices show long, red streaks or red spots. A healthcare provider can see through a thin, flexible tube, called an endoscope, is passed through the throat. These marks suggest a high risk of bleeding.
  • Cirrhosis or liver failure. More often, the more severe the liver disease, the more likely it is that esophageal varices are bleeding.
  • Continued consumption of alcohol. The risk of variceal bleeding is much greater for people who continue to drink, especially if the disease is alcohol-related.

If someone had bleeding from esophageal varices before, you are more likely to have varicose veins that bleed again.

Complications

The most serious complication of esophageal varices bleeding. If a person has an episode of bleeding, the risk of another episode of bleeding increases significantly. If a person loses enough blood, you may go into shock, which can lead to death.

Prevention

Currently, no treatment can prevent the development of esophageal varices in people with cirrhosis. While the beta-blocker drugs are effective in the prevention of bleeding in many people who have esophageal varices, they don't stop esophageal varices of the training.

If you have been diagnosed with liver disease, please consult a medical professional about strategies to avoid the complications of the liver disease. To keep your liver healthy:

  • Do not drink alcohol. People with liver disease are often advised to stop drinking alcohol, the liver processes alcohol. Drinking alcohol can stress an already vulnerable to the liver.
  • Eat a healthy diet. Choose a diet full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried food that you eat.
  • Maintain a healthy weight. An excessive amount of body fat can harm your liver. Obesity is associated with an increased risk of complications of cirrhosis. Lose weight if you are obese or overweight.
  • The use of chemicals with moderation and care. Follow the instructions in household chemicals, such as cleaning supplies and insecticides. If you work around chemicals, follow all safety precautions. The liver removes toxins from your body, so give it a rest, by limiting the amount of toxins that must be processed.
  • To reduce the risk of hepatitis. Sharing needles and having unprotected sex can increase your risk of contracting hepatitis B and C. protect from sexual abstinence or use a condom if you decide to have sex. Get tested for exposure to the hepatitis a, B and C, since the infection can worsen liver disease. Also ask your health care professional if you should be vaccinated against hepatitis a and hepatitis B.

Diagnosis

If someone is diagnosed with cirrhosis, a health professional will usually screen for esophageal varices. How often screening tests are performed depends on someone of the condition. The main tests used to diagnose esophageal varices are:

  • The upper gastrointestinal endoscopy.An upper endoscopy uses a tiny camera on the end of a flexible tube to visually examine your upper digestive system. This procedure is the preferred method for the detection of esophageal varices. The small camera allows a medical professional to examine the esophagus, stomach and beginning of the small intestine, called the duodenum. The professional to do the endoscopy search dilation of the veins. If found, the enlarged veins are measured and tested to the red of the stripes and red patches, which usually indicate a significant risk of bleeding. The treatment can be carried out during the exam.
  • Imaging tests. Both abdominal CT and Doppler ultrasound of the splenic and portal veins may suggest the presence of esophageal varices. An ultrasound test called transient elastography can be used to measure the formation of scar tissue in the liver. This can help determine if a person has portal hypertension, which can lead to esophageal varices.

The upper gastrointestinal endoscopy. An upper endoscopy uses a tiny camera on the end of a flexible tube to visually examine your upper digestive system. This procedure is the preferred method for the detection of esophageal varices. The small camera allows a medical professional to examine the esophagus, stomach and beginning of the small intestine, called the duodenum.

The professional to do the endoscopy search dilation of the veins. If found, the enlarged veins are measured and tested to the red of the stripes and red patches, which usually indicate a significant risk of bleeding. The treatment can be carried out during the exam.

Treatment

The main objective in the treatment of esophageal varices is to prevent bleeding. Bleeding from esophageal varices are potentially fatal. If bleeding happens, treatments are available to try to stop the bleeding.

The treatment to prevent bleeding

Treatments to reduce the blood pressure in the portal vein may reduce the risk of bleeding esophageal varices. Treatments may include:

  • Medications to reduce the pressure in the portal vein. A type of blood pressure medication called a beta-blocker can help to reduce the blood pressure in the portal vein. This can reduce the likelihood of bleeding. Medications Beta blockers include propranolol (Inderal, Innopran XL) and nadolol.
  • The use of rubber bands to tie off the bleeding of the veins.If the esophageal varices seem to have a high risk of bleeding, or if the varices have bled before, a health professional may recommend a procedure called endoscopic band ligation. The use of an endoscope, the care professional uses suction to pull varicose veins on a camera on the end of the endoscope and wraps them with an elastic band. This, in essence, "suffocates" the veins so they can't bleed. Endoscopic band ligation carries a small risk of complications, such as bleeding and formation of scar tissue in the esophagus.

The use of rubber bands to tie off the bleeding of the veins. If the esophageal varices seem to have a high risk of bleeding, or if the varices have bled before, a health professional may recommend a procedure called endoscopic band ligation.

The use of an endoscope, the care professional uses suction to pull varicose veins on a camera on the end of the endoscope and wraps them with an elastic band. This, in essence, "suffocates" the veins so they can't bleed. Endoscopic band ligation carries a small risk of complications, such as bleeding and formation of scar tissue in the esophagus.

Treatment if you're bleeding

Bleeding from esophageal varices are life-threatening, and immediate treatment is essential. The treatments used to stop the bleeding and reverse the effects of blood loss include:

  • The use of rubber bands to tie off the bleeding of the veins. A health professional can wrap elastic bands around the esophageal varices during an endoscopy.
  • Medications to reduce the flow of blood in the portal vein. Medications such as octreotide (Sandostatin) and vasopressin (Vasostrict) slow the flow of blood to the portal vein. The medicine is usually followed for up to five days after a bleeding episode.
  • Divert the blood flow from the portal vein.If the medicine and endoscopy treatments do not stop the bleeding, a care professional may recommend a procedure called transjugular intrahepatic portosystemic shunt (TIPS). The derivation is an opening that is created between the portal vein and the hepatic vein which carries blood from the liver to the heart. The shunt reduces the pressure in the portal vein and often stops the bleeding of esophageal varices. But COUNCILS can cause serious complications, including liver failure and mental confusion. These symptoms may develop when the toxins that the liver normally filter is passed through the bypass directly into the bloodstream. ADVICE is mainly used when all other treatments have failed or as a temporary measure in people waiting for a liver transplant.
  • Exert pressure on the veins to stop the bleeding.If the medicine and endoscopy treatments do not work, a care professional can try to stop the bleeding by applying pressure in esophageal varices. A way to temporarily stop the bleeding is to inflate a balloon to put pressure in the varicose veins of up to 24 hours, a procedure called balloon tamponade. Balloon tamponade is a temporary measure before other treatments can be performed, such as TIPS. This procedure carries a high risk of rebleeding after the balloon is deflated. Balloon tamponade can also cause serious complications, including a rupture in the esophagus, which can lead to death.
  • The restoration of the blood volume. A transfusion may be necessary to replace the loss of blood, and a blood clotting factor can be given to stop the bleeding.
  • The prevention of infection. There is an increased risk of infection with the bleeding, so you may be prescribed an antibiotic to prevent infection.
  • Replace the diseased liver with a healthy one. Liver transplantation is an option for people with severe liver disease or those who experience recurrent bleeding from esophageal varices. Although liver transplantation is often successful, the number of people waiting for transplants far exceeds the available organs.

Divert the blood flow from the portal vein. If the medicine and endoscopy treatments do not stop the bleeding, a care professional may recommend a procedure called transjugular intrahepatic portosystemic shunt (TIPS).

The derivation is an opening that is created between the portal vein and the hepatic vein which carries blood from the liver to the heart. The shunt reduces the pressure in the portal vein and often stops the bleeding of esophageal varices.

But COUNCILS can cause serious complications, including liver failure and mental confusion. These symptoms may develop when the toxins that the liver normally filter is passed through the bypass directly into the bloodstream.

ADVICE is mainly used when all other treatments have failed or as a temporary measure in people waiting for a liver transplant.

Exert pressure on the veins to stop the bleeding. If the medicine and endoscopy treatments do not work, a care professional can try to stop the bleeding by applying pressure in esophageal varices. A way to temporarily stop the bleeding is to inflate a balloon to put pressure in the varicose veins of up to 24 hours, a procedure called balloon tamponade. Balloon tamponade is a temporary measure before other treatments can be performed, such as TIPS.

This procedure carries a high risk of rebleeding after the balloon is deflated. Balloon tamponade can also cause serious complications, including a rupture in the esophagus, which can lead to death.

Bleeding

There is a high risk of bleeding recurs in people who have had bleeding from esophageal varices. Beta-blockers and endoscopic band ligation are the recommended treatments to help prevent rebleeding.

After the first bands of treatment, a health professional is a repeat upper endoscopy at regular intervals. If necessary, more bands can be made until the esophageal varices have been or are small enough to reduce the risk of major hemorrhage.

Potential future treatment

The researchers are exploring experimental emergency therapy to stop the bleeding from esophageal varices which involves spraying an adhesive powder. The powder hemostat is given through a catheter during an endoscopy. When sprayed on the esophagus, hemostatic powder sticks to the varicose veins, and can stop the bleeding.

Another possible way to stop the bleeding, when all other measures fail is the use of self-expanding metal stents (SEMS). SEMS can be placed during an endoscopy and stop the bleeding by applying pressure to the bleeding of the esophageal varices.

However, SEMS could damage the tissue and can migrate after being placed. The stent should be removed within the seven days and the bleeding could occur again. This option is experimental and is not yet widely available.

Preparing for your appointment

You could start by watching someone in their team of primary health care. Or you may be referred immediately to a healthcare provider who specializes in digestive disorders, called a gastroenterologist. If you are having symptoms of internal bleeding, call 911 or the local emergency number to be taken to the hospital for urgent care.

Here's some information to help you prepare for an appointment.

What you can do

When you make the appointment, ask if there is something that you need to do in advance, such as fasting before a specific test. Make a list of:

  • Your symptoms, including any that seem unrelated to the reason for your appointment.
  • Key personal information, including major stresses, recent life changes or recent travel, family, and the medical staff of the story, and his use of alcohol.
  • All the medications, vitamins, or other supplements you are taking, including dosage.
  • Questions during your appointment.

Have a friend or family member, if possible, to help you remember the information they give you.

For esophageal varices, questions include:

  • What is likely causing my symptoms?
  • What other possible causes are there?
  • What tests do I need?
  • What is the best course of action?
  • What are the side effects of the treatments?
  • Are my symptoms likely to repeat, and what can I do to prevent that?
  • I have other health conditions. How can I best manage them together?
  • There are restrictions that must be followed?
  • You should see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

You'll likely be asked a few questions, such as:

  • When did your symptoms begin?
  • The symptoms stayed the same or worsened?
  • How severe are the symptoms?
  • Have you had symptoms of bleeding such as blood in the stool or in vomit?
  • Has had hepatitis or yellowing of the eyes or skin (jaundice)?
  • Have you traveled recently? Where?
  • If you drink alcohol, when did you start and how much did you drink?"

What you can do in the meantime

If you have blood in the vomit or stool, while you're waiting for your appointment, please call 911 or your local emergency number or go to an emergency room immediately.

Symptoms and treatment of Esophageal varices