Esophageal varices
DEFINITION
Esophageal varices are abnormal, enlarged veins in the lower part of the esophagus — the tube that connects the throat and stomach. Esophageal varices occur most often in people with serious liver diseases.
Esophageal varices develop when normal blood flow to the liver is obstructed by scar tissue in the liver or a clot. Seeking a way around the blockages, blood flows into smaller blood vessels that are not designed to carry large volumes of blood. The vessels may leak blood or even rupture, causing life-threatening bleeding.
A number of drugs and medical procedures can help prevent and stop bleeding from esophageal varices.
CAUSES
Esophageal varices sometimes form when blood flow to your liver is obstructed, most often by scar tissue in the liver caused by liver disease. The blood flow to your liver begins to back up, increasing pressure within the large vein (portal vein) that carries blood to your liver. This pressure (portal hypertension) forces the blood to seek alternate pathways through smaller veins, such as those in the lowest part of the esophagus. These thin-walled veins balloon with the added blood. Sometimes the veins can rupture and bleed.
Causes of esophageal varices include:
- Severe liver scarring (cirrhosis). A number of liver diseases can result in cirrhosis, such as hepatitis infection, alcoholic liver disease, fatty liver disease and a bile duct disorder called primary biliary cirrhosis. Esophageal varices occur in about 40 percent of people who have cirrhosis.
- Blood clot (thrombosis). A blood clot in the portal vein or in a vein that feeds into the portal vein called the splenic vein can cause esophageal varices.
- A parasitic infection. Schistosomiasis is a parasitic infection found in parts of Africa, South America, the Caribbean, the Middle East and Southeast Asia. The parasite can damage the liver, as well as the lungs, intestine and bladder.
- Budd-Chiari syndrome. This rare condition causes blood clots that can block the veins that carry blood out of your liver.
SYMPTOMS
Esophageal varices usually don’t cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices include:
- Vomiting blood
- Black, tarry or bloody stools
- Shock (in severe case)
Your doctor may suspect varices if you have any of the following signs of liver disease:
- Yellow coloration of your skin and eyes (jaundice)
- A cluster of tiny blood vessels on the skin, shaped like a spider (spider nevi)
- Reddening of the skin on the palm of your hands (palmar erythema)
- A hand deformity known as Dupuytren’s contracture
- Shrunken testicles
- Swollen spleen
- Fluid buildup in your abdomen (ascites)
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you. If you’ve been diagnosed with liver disease, ask your doctor about your risk of esophageal varices and how you may reduce your risk of these complications. Ask your doctor whether you should undergo an endoscopy procedure to check for esophageal varices.
If you’ve been diagnosed with esophageal varices, your doctor may instruct you to be vigilant for signs of bleeding. Bleeding esophageal varices are an emergency. Call 911 or your local emergency services right away if you experience bloody vomit or bloody stools.
