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Definition Return to top
Bleeding esophageal varices occur when veins in the walls of the lower part of the esophagus and sometimes the upper part of the stomach are wider than normal (dilated).
Causes Return to top
Bleeding varices are a life-threatening complication of increased blood pressure in the portal vein caused by liver disease (portal hypertension). The portal vein carries blood from the intestine to the liver.
Increased pressure causes the veins to balloon outward. The vessels may break open (rupture). Any cause of chronic liver disease can cause bleeding varices.
Symptoms Return to top
Exams and Tests Return to top
Tests to determine where the bleeding is coming from and detect active bleeding include:
Treatment Return to top
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.
In endoscopic therapy, a small lighted tube called an endoscope is used. The health care provider may inject the varices directly with a clotting medicine, or place a rubber band around the bleeding veins. This procedure is used in acute bleeding episodes and as preventive therapy.
Acute bleeding may also be treated with a tube that is inserted through the nose into the stomach and inflated with air to produce pressure against the bleeding veins (balloon tamponade).
Once acute bleeding has been stopped, several treatments are available:
Emergency surgery may be used (rarely) to treat patients if other therapy fails. Portacaval shunts or surgical removal of the esophagus are two treatment options, but these procedures are risky.
Patients with bleeding varices from liver disease may need a liver transplant.
Outlook (Prognosis) Return to top
Bleeding often comes back without treatment. Bleeding esophageal varices are a serious complication of liver disease and have a poor outcome.
Possible Complications Return to top
When to Contact a Medical Professional Return to top
Call your health care provider if you vomit blood or have black tarry stools.
Prevention Return to top
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 Return to topGoldman L, Ausiello DA. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007. Update Date: 2/20/2008 Updated by: Christian Stone, MD, Division of Gastroenterology, Washington University in St. Louis, School of Medicine, St. Louis, MO. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.