Esophageal Varices – Symptoms and Causes
Overview
Esophageal varices are swollen, enlarged veins that form in the esophagus, which connects the throat to the stomach. These abnormal veins typically develop in people who have serious liver problems.
When blood clots or scarring block normal blood flow to the liver, the blood must find alternate routes. This causes blood to flow into smaller vessels that aren’t built to handle such large volumes.
These overworked vessels become fragile and may start to leak blood. In severe cases, they can rupture completely, causing dangerous bleeding that requires immediate medical attention. This bleeding can be life-threatening if not treated promptly.
Healthcare providers can offer several treatment options, including medications and medical procedures, to help prevent bleeding or stop it when it occurs.
Signs and Symptoms
Esophageal varices typically cause no symptoms until they bleed. When bleeding occurs, people may experience:
- Vomiting large amounts of blood
- Black, tarry, or bloody stools
- Feeling dizzy or lightheaded due to blood loss
- Loss of consciousness in severe cases
Doctors might suspect esophageal varices in people who show signs of liver disease or have cirrhosis. These signs include:
- Jaundice (yellowing of the skin and eyes)
- Easy bleeding or bruising
- Ascites (fluid buildup in the abdomen)
When to Contact a Doctor
If you notice any symptoms that concern you, schedule an appointment with your doctor. People diagnosed with liver disease should ask about their risk for developing esophageal varices and how to reduce it.
Ask if you should undergo testing to check for this condition. For those already diagnosed with esophageal varices, watch closely for any signs of bleeding.
Bleeding varices require immediate emergency care. Call 911 right away if you vomit blood or notice black or bloody stools, as these are warning signs of a serious medical emergency.
Causes
Esophageal varices develop primarily when blood cannot flow properly through the liver. This blockage often results from liver scarring, also called cirrhosis. When scarring occurs, blood backs up in the portal vein, creating high pressure known as portal hypertension.
This increased pressure forces blood to find alternative routes through smaller veins in the lower esophagus. These thin-walled veins swell from the extra blood volume and may eventually burst, causing bleeding.
Several specific conditions can trigger esophageal varices:
Cirrhosis is the most common cause. This severe liver scarring can develop from:
- Hepatitis infections
- Alcoholic liver disease
- Fatty liver disease
- Primary biliary cholangitis (a bile duct disorder)
Blood clots can also lead to varices. Clots form in either:
- The portal vein
- The splenic vein (which feeds into the portal vein)
Schistosomiasis, a parasitic infection found in parts of:
- Africa
- South America
- The Caribbean
- Middle East
- East Asia
This parasite can harm the liver along with other organs like the lungs, intestines, and the bladder.
When blood flow meets resistance, it seeks the path of least resistance. Unfortunately, the delicate veins in the esophagus aren’t built to handle this extra blood pressure, making them prone to dangerous swelling and rupture.
Risk Factors
Several factors can increase the chance of bleeding in esophageal varices. Not everyone with advanced liver disease who develops these blood vessels will experience bleeding.
The risk increases with higher pressure in the portal vein. As this pressure rises, so does the likelihood of bleeding.
The size of the varices matters significantly. Larger varices have a greater chance of rupturing and causing bleeding.
Visual markers can indicate danger. Red streaks or spots on the varices, visible during an endoscope examination, suggest a high bleeding risk.
People with more advanced cirrhosis or liver failure face greater bleeding risks. The severity of liver disease often correlates with bleeding likelihood.
Alcohol consumption plays a critical role in bleeding risk, especially in alcohol-related liver disease. Those who continue drinking have a substantially higher chance of variceal bleeding.
Previous bleeding episodes are important predictors. If someone has experienced bleeding from esophageal varices before, they have a higher chance of bleeding again in the future.
Complications
Bleeding is the most dangerous problem with esophageal varices. Once a person has bled once, they face a much higher risk of bleeding again. Severe blood loss can lead to shock, which can be fatal.
Prevention
For people with cirrhosis, preventing esophageal varices remains challenging. No treatments currently exist that can stop these varices from forming. However, beta blockers help many patients prevent bleeding once varices have developed.
If you have liver disease, several strategies can help maintain liver health and potentially reduce complications:
Avoid alcohol completely. The liver processes alcohol, and drinking puts additional stress on an already compromised liver. Healthcare professionals typically recommend complete alcohol abstinence for those with liver disease.
Focus on nutrition. A liver-friendly diet includes:
- Plenty of fresh fruits and vegetables
- Whole grain products
- Lean protein sources
- Limited fried and fatty foods
Control your weight. Excess body fat can further damage your liver and increase cirrhosis complications. If you’re overweight or obese, a gradual weight loss plan may be beneficial.
Be careful with chemicals. Your liver filters toxins from your body. Limit its workload by:
- Following directions on household cleaning products
- Using protective equipment when working with chemicals
- Minimizing exposure to harmful substances
Prevent hepatitis infections. Hepatitis can worsen existing liver disease. Protect yourself by:
- Avoiding needle sharing
- Practicing safe sex
- Getting tested for hepatitis A, B, and C
- Discussing hepatitis A and B vaccinations with your healthcare provider
