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Definition

Bleeding esophageal varices are very swollen veins in the walls of the lower part of the esophagus (the tube that connects your throat to your stomach) that begin to bleed.

Causes, incidence, and risk factors

Scarring (cirrhosis) of the liver is the most common cause of esophageal varices. This scarring prevents blood from flowing through the liver. As a result, more blood flows through the veins of the esophagus.

This extra blood flow causes the veins in the esophagus to balloon outward. If these veins break open (rupture), they can cause severe bleeding.

Any cause of chronic liver disease can cause varices.

The swollen veins (varices) can also occur in the upper part of the stomach.

Symptoms

People with chronic liver disease and esophageal varices may have no symptoms.

If there is only a small amount of bleeding, the only symptom may be dark or black streaks in the stools.

If larger amounts of bleeding occur, symptoms may include:

Signs and tests

Physical examination:

Tests to determine where the bleeding is coming from and detect active bleeding include:

  • Esophagogastroduodenoscopy (EGD)
  • Tube through the nose into the stomach (nasogastric tube) to look for signs of bleeding

Some doctors recommend EGD for patients who are newly diagnosed with mild-to-moderate cirrhosis to screen for esophageal varices and treat them before there is bleeding.

Treatment

The goal of treatment is to stop acute bleeding as soon as possible, and treat varices with medicines and medical procedures. Bleeding must be controlled quickly to prevent shock and death.

If massive bleeding occurs, the patient may be placed on a ventilator to protect the airways and prevent blood from going down into the lungs.

Treatments for acute bleeding:

  • A small lighted tube called an endoscope may be used. The health care provider may inject the varices directly with a clotting medicine, or place a rubber band around the bleeding veins.
  • A medication that tightens blood vessels (vasoconstriction) may be used. Examples include octreotide or vasopressin.
  • A tube may be inserted through the nose into the stomach and inflated with air. This produces pressure against the bleeding veins (balloon tamponade).

Once the bleeding is stopped, varices can be treated with medicines and medical procedures to prevent future bleeding:

  • Drugs called beta blockers, such as propranolol and nadolol, are used to reduce the risk of bleeding.
  • A small lighted tube called an endoscope may be used to place a rubber band around the bleeding veins.
  • Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure to create new connections between two blood vessels in your liver. This can decrease pressure in the veins and prevent bleeding episodes from happening again.

Emergency surgery may be used (rarely) to treat patients if other therapy fails. Portocaval shunts or surgery to remove the esophagus are two treatment options, but these procedures are risky.

Patients with bleeding varices from liver disease may need additional treatment of their liver disease, including a liver transplant.

Expectations (prognosis)

Bleeding often comes back without treatment. Bleeding esophageal varices are a serious complication of liver disease and have a poor outcome.

ComplicationsCalling your health care provider

Call your health care provider or go to an emergency room if you vomit blood or have black tarry stools.

Prevention

Treating the causes of liver disease may prevent bleeding. Preventive treatment of varices with medications such as beta blockers or with endoscopic banding may help prevent bleeding. Liver transplantation should be considered for some patients.

References

Garcia-Tsao G, Sanyal AJ, Grace ND, Carey WD; Practice Guidelines Committee of American Association for Study of Liver Diseases; Practice Parameters Committee of American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007;102:2086-2102.

Garcia-Tsao G. Cirrhosis and its sequellae. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 157.

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Related Questions

What is sclerotherapy for esophageal varices?

a treatment for esophageal bleeding that involves the use of an endoscope and the injection of a sclerosing solution into veins.


What conditions are treated with sclerotherapy?

In most hospitals, sclerotherapy for esophageal varices is the treatment of choice to stop esophageal bleeding during acute episodes, and to prevent further incidences of bleeding.


What does sclerotherapy for esophageal varices involve?

Sclerotherapy for esophageal varices involves injecting a sclerosing agent into the varices to induce scarring and collapse them. This helps stop bleeding and reduce the risk of complications such as rupture. It is commonly used as a treatment option for managing and preventing bleeding episodes in patients with esophageal varices.


How long can you live with esopagal varices?

The main danger of death with esophageal varices is if they rupture, causing massive bleeding into the esophagus (windpipe). If a patient has had a previous rupture of their esophageal varices, they have a 70% chance of it bleeding again, and each time the vessels rupture there is about a 30% chance of it being fatal. If you have esophageal varices, then it is a condition you should consult with your doctor about. It needs adequate management to help prevent rupture, and also to treat the underlying cause (most often cirrhosis).


What is the CPT code a direct ligation of esophageal varices?

The CPT code for "direct ligation of esophageal varices" is 43400.


Can you fly with esophageal varices?

endescopy?


What happens when a esophageal varices rupture?

Once the esophageal varices rupture , it will compromised of Hemodynamic Stability of the patient andrisk of aspiration it,s more likely. As we known esophageal vein supply is from portal vein , so it should aggressively treated when the ruptureishappened. The managment is included Emergent Endoscopic and if the bleeding uncontrollable , surgery is more likely


What are esophageal varices?

Esophageal varices are abnormal, enlarged veins in the lower portion of the esophagus. They develop when blood flow to the liver is slowed, and blood gets backed up into the smaller vessels of the esophagus.


Can you fly with 3 plus esophageal varices?

Flying with esophageal varices can pose risks, especially if there is a potential for bleeding or other complications. It's crucial to consult a healthcare professional before traveling, as they can assess your specific condition and recommend precautions. If your varices are well-managed and stable, flying may be possible, but always prioritize safety and follow medical advice.


What are similarities between esophageal varices and hemorrhoids?

varicose


Can the spleen cause esophageal varices?

Esophageal varices are typically caused by portal hypertension due to liver disease, not by the spleen. However, if the spleen becomes enlarged (splenomegaly) due to certain conditions like cirrhosis, it can contribute to an increase in portal hypertension and indirectly worsen esophageal varices.


What are the symptoms of esophageal varices?

The symptoms of esophageal varices are vomiting blood, black stool and in severe cases shock. An esophageal varice is also a sign of liver disease. Jaundice, a yellowing of the skin and eyes, is a common sign of this.

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