What Is It?

Esophageal varices are swollen veins in the lining of the lower esophagus near the stomach. Gastric varices are swollen veins in the lining of the stomach. Swollen veins in the esophagus or stomach resemble the varicose veins that some people have in their legs. Because the veins in the esophagus are so close to the surface of the esophagus, swollen veins in this location can rupture and cause dangerous bleeding. Esophageal varices almost always occur in people who have cirrhosis of the liver. Cirrhosis causes scarring of the liver, which slows the flow of blood through the liver. Scarring causes blood to back up in the portal vein, the main vein that delivers blood from the stomach and intestines to the liver. This "back up" causes high blood pressure in the portal vein and other nearby veins. This is called portal hypertension. Less common causes of portal hypertension and esophageal varices include blood clots in the veins leading to and from the liver and schistosomiasis. Schistosomiasis is a parasitic infection that can clog up the liver, causing pressure to back up in the portal vein. The backup of blood forces veins to enlarge in the vicinity of the stomach and esophagus. The veins don't enlarge in a uniform fashion. Esophageal varices usually have enlarged, irregularly shaped bulbous regions (varicosities) that are interrupted by narrower regions. These abnormal dilated veins rupture easily and can bleed profusely because:

 The pressure inside the varices is higher than the pressure inside normal veins  The walls of the varices are thin  The varices are close to the surface of the esophagus.

Symptoms
Portal hypertension often does not cause any symptoms. Sometimes it is first discovered when the varices bleed. When significant bleeding occurs, a person will vomit blood, often in large amounts. People with massive bleeding feel dizzy and may lose consciousness. Some people bleed in smaller amounts over a longer period, and they swallow the blood rather than vomit. Their stools may contain red or tarry-black blood. People with esophageal varices caused by cirrhosis will usually have other symptoms related to their liver disease.

Diagnosis
To diagnose esophageal varices, a doctor will use an instrument called an endoscope. It is a thin, flexible tube with a camera at its tip. The doctor inserts the endoscope into the mouth. The scope is gently advanced into the esophagus to search for esophageal varices. If the varices are actively bleeding or have recently bled, this procedure will be done as an emergency. Tiny instruments may be attached to the endoscope to provide treatment at the same time.

Expected Duration
Bleeding from esophageal varices usually does not stop without treatment. Bleeding esophageal varices is a life-threatening emergency. About 50% of people who have bleeding from esophageal varices will have the problem return during the first one to two years. The risk of recurrence can be reduced with treatment.

A TIPS procedure is done by a specialized radiologist (interventional radiologist). Sorbitrate) -. more band ligation procedures are done to try to get rid of the varices. a catheter is threaded through a vein in the neck into one of the hepatic veins. Pressure is reduced by creation of a "shunt. The stent is a wire mesh tube which is designed to prop open a vein or artery. The doctor threads a wire into the catheter. If the bleeding is caused by ruptured esophageal varices. treatment may be able to prevent bleeding. The balloon is deflated and the catheter is removed. It stays. This treatment includes endoscopic banding or sclerotherapy (described in the Treatment section) to shrink the varices. Once the bleeding is controlled. Patients with hepatitis B or hepatitis C also are at risk of developing cirrhosis. intravenous drugs may be given to decrease blood flow to the intestine. This slows the bleeding and allows a blood clot to form over the ruptured vessel. A rubber band is used to tie off the bleeding portion of the vein. There is no vaccine to prevent people from contracting hepatitis C. The doctor guides the catheter inside the liver to a place where one of the portal veins sits close to the hepatic vein. young teens and all health care workers and older adults at risk of hepatitis B should be vaccinated against the disease. A drug is injected into the bleeding vein. A tunnel has been created inside the liver that allows blood to flow faster through the portal vein into the hepatic vein. Children. treatment is done to try to prevent more bleeding in the future. The main cause of cirrhosis is alcohol abuse. Options for creating a shunt include:  Transjugular intrahepatic portal-systemic shunt (TIPSS). Intravenous drug use is a major risk factor for hepatitis B and C. The wire and catheter come out. Usually blood must trickle through liver tissue in order to travel from the veins below the liver (the portal veins) into the three veins that drain the liver from above (the hepatic veins). A different catheter with a balloon and stent at the tip moves into the newly created channel. Efforts are then made to stop the bleeding. This "trickling" is too slow when the liver is scarred. and decreases the risk of bleeding in the future. Treatment Emergency treatment for bleeding esophageal varices begins with blood and fluids given intravenously (into a vein) to compensate for blood loss. The stent opens when the balloon is inflated." which is a channel or "pipeline" that diverts blood away from the high-pressure veins. At the same time. nadolol (Corgard) and isosorbide mononitrate (Isordil. Drugs to reduce portal blood pressure -. The tip of the wire is pushed through the wall of the hepatic vein into the portal vein. causing it to constrict (narrow). For this procedure. This treatment reduces the excess pressure in the esophageal varices. A TIPSS procedure implants a wide tube (a stent) within the liver so that much of the blood traveling through the liver can flow quickly through the liver. The balloon is inflated. If you have esophageal varices.  Sclerotherapy. Endoscopy is done to identify the site of the bleeding. Bleeding esophageal varices can result in a very large amount of blood loss and many units of blood may need to be transfused. a procedure to minimize pressure in the veins is sometimes necessary. one of two endoscopic treatments may be used:  Band ligation.such as propranolol (Inderal). . In some cases.also can be used alone or in combination with endoscopic techniques.Prevention The best way to prevent esophageal varices is to reduce your risk of cirrhosis. For people with severe cirrhosis.

patients need to have an operation to create a shunt to divert portal blood away from the liver into another vein. some blood will pass through the liver without being thoroughly detoxified by enzymes within the liver. Medication can reduce symptoms of encephalopathy. Like TIPSS. Surgery. When to Call a Professional Bleeding from esophageal varices can be life threatening. called encephalopathy. Because of this some people who have had a TIPS procedure develop symptoms of confusion. If you vomit blood or notice blood in your stool. Patients can lose massive amounts of blood in a short time. . this treatment reduces the pressure in the varices. The risk can be reduced by endoscopic and drug treatments. Rarely. Prognosis At least 50% of people who survive bleeding esophageal varices are at risk of more bleeding during the next one to two years. causing extremely low blood pressure and shock. you should always seek immediate medical attention. If a TIPSS procedure or other shunt procedure is required. Natural waste products in the blood can accumulate if the blood is not detoxified by the liver.

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