Esophageal Varices

Varices are abnormally enlarged veins in your esophagus. Varices occur when blood flow to the liver is blocked and your body essentially re-routes the blood into the smaller vessels causing strain and enlargement of the veins in the esophagus. Esophageal varices can be a life threatening condition if these enlarged vessels begin to leak or rupture (break) under the strain.

Many individuals do not realize they have varices until they bleed and cause other symptoms including vomiting blood or black, tarry stools resulting from swallowing blood. Sudden and severe bleeding from varices is an emergent condition and can cause signs of significant blood loss including loss of consciousness, dizziness, pale and clammy skin and irregular bleeding.

Varices are caused by any significant liver disease; most commonly cirrhosis (when scar tissue takes over healthy tissue in the liver). Over 90% of individuals with cirrhosis will develop varices. Cirrhosis is commonly caused by viral hepatitis, alcoholic liver disease, fatty liver and other liver conditions.

Diagnosing varices is done through endoscopy (use of a small camera to inspect your esophagus) and medical imaging such as CT or MRI to examine the vein structure in your esophagus, liver and surrounding structures. Individuals with advanced liver disease may be screened for varices even if no symptoms currently exist to identify the condition early and prevent possible complications.

Varices can be life threatening and treatment is based on prevention of further liver damage, preventing current varices from bleeding and controlling any bleeding that may occur. Lifestyle changes including diet, avoiding alcohol and smoking and maintaining a healthy weight is recommended. Additionally, medication may be prescribed to lower blood pressure to prevent further varices from forming or enlarging.

Active bleeding requires immediate intervention including ligation where a physician applies bands to the varices and cutting off the blood flow to that area. This is done in conjunction with the endoscopy procedure. Individuals with severe cirrhosis and bleeding from varices may undergo transjugular intrahepatic portal-systemic shunting (TIPS) to reduce portal blood pressure. TIPS is performed by a radiologist and a shunt (new channel or opening) is placed to improve blood flow to the liver.