What Are Esophageal Varices?

Esophageal varices are swollen blood vessels in the lower part of the esophagus. Everyone has veins in their esophagus. But in people who have liver disease, these veins can become engorged and much larger than normal. Varices can be a serious problem if they start bleeding. Here we will discuss why esophageal varices develop, how to know if you have them, and how treatment works.

What causes esophageal varices? 

Esophageal varices develop as a result of long-term liver damage. With liver disease, blood doesn’t flow through the liver as well as normal. This could be from cirrhosis — scarring of the liver. Or it could be from blood clots that form in the veins of the liver.

When blood flow slows down, it can then back up behind the liver. Think of the liver like a dam that stops water from flowing. When this happens, one of the places blood collects is in the nearby veins of the esophagus. These veins then start to swell and become larger than normal to hold the extra blood. This also makes the veins more fragile, so they bleed easily.

What are the symptoms of esophageal varices? 

Esophageal varices don’t cause symptoms if they aren’t bleeding. In fact, people might not know they have them unless an upper endoscopy spots them. This is a procedure in which a gastroenterologist uses a small camera to look at the esophagus and stomach.

When varices start to bleed, they may lead to the following symptoms:

• Bloody vomit: It may appear bright red or look like it contains coffee grounds.

• Dark or black stool: This is a sign of digested blood in bowel movements. Stool might become bright red if the bleeding is severe or brisk enough.

• Lightheadedness, weakness, or fainting: These are all symptoms of blood loss.

This bleeding is serious and life-threatening. So if you have any of these symptoms, give them the attention they deserve and connect with a provider to get immediate treatment. 

What is the treatment for esophageal varices?

The treatment for esophageal varices depends on whether they’re bleeding. If they’re bleeding, you will need prompt medical care to stop the bleeding. Once the bleeding is controlled, or if they were not bleeding in the first place, there are some other treatments that can prevent bleeding.

Bleeding esophageal varices

Bleeding varices are a medical emergency that need immediate treatment. This treatment includes:

• Acid-suppressing medications: Pantoprazole (Protonix) is a common example. Providers usually give these through an intravenous (IV) infusion in emergent cases.

• Medications that shrink the blood vessels: Examples include octreotide and vasopressin.

• Antibiotics: These prevent any blood infections, which can happen when the blood vessels are open and exposed to bacteria in the digestive tract.

• Upper endoscopy: This procedure is the most definitive treatment. A gastroenterologist ties off the bleeding vessels or injects medications directly into the vessel to help them clot.

More drastic measures may be necessary in rare cases of severe bleeding. For example, a provider may need to insert a special balloon into the esophagus. The balloon expands to block off the bleeding. During this procedure the person receives sedation and support from a ventilator so they don’t experience any discomfort. It can temporarily stop the bleeding and give the healthcare team more time to properly treat the bleeding vessels.

Preventing esophageal varices from bleeding

In the case that you have esophageal varices that aren’t bleeding, the goal is to prevent them from bleeding. The good news is that there are some treatment options to prevent bleeding. These include:

• Beta blockers: Examples include carvedilol, propranolol, or nadolol. These medications reduce the blood pressure in the swollen veins, which helps them shrink. They also help to prevent rupture.

• Upper endoscopy treatment: A provider can tie off or treat the blood vessels with a blood clotting agent during this procedure, even if they aren’t bleeding.

• Portocaval shunt: This is a surgical procedure in which a surgeon makes a connection between the veins of the liver and the veins of the rest of the body. This prevents the buildup of pressure that causes esophageal varices.

People who have esophageal varices will need regular endoscopies to watch them, usually every 1 to 2 years.