Bleeding Esophageal Varices

Bleeding Esophageal Varices

What are esophageal varices? — Esophageal varices are swollen blood vessels in the esophagus, which is the tube that connects the mouth to the stomach (figure 1). Esophageal varices often happen in people with serious liver disease, called "cirrhosis."
What are the symptoms of esophageal varices? — Esophageal varices do not cause symptoms until they leak or burst. This causes bleeding, which can be very serious. Signs of bleeding from esophageal varices include:
Vomiting blood
Dark-colored or black bowel movements
Bloody bowel movements or diarrhea
Feeling lightheaded
Passing out
If you have liver disease and get one of more of these symptoms, call for an ambulance (in the US and Canada, dial 9-1-1). Do not drive yourself to the hospital or have another person drive you.
Is there a test for esophageal varices? — Yes. All people who have cirrhosis should have a test called an "upper endoscopy" to check for esophageal varices (figure 2).
For an upper endoscopy, the doctor puts a thin, flexible tube into your mouth down your throat and into your esophagus. The tube (called an endoscope) has a camera and a light on it. This allows the doctor to see inside your esophagus, stomach, and the first part of your intestine.
Sometimes, doctors do an endoscopy using a small capsule with a tiny camera inside. You swallow the capsule while lying on your right side and sip water every 30 seconds. The capsule sends photos of the lining of your esophagus and stomach to a device outside your body. A doctor then looks for any problems in the photos.
If you have cirrhosis, you should have an upper endoscopy every 1 to 3 years. The doctor will check to see if you have new varices or if the ones you have are getting larger.
How are esophageal varices treated? — Treatments that can make varices less likely to bleed include:
Taking medicines called beta-blockers – These are also used to treat high blood pressure. Examples include propranolol (brand name: Inderal) and nadolol (brand name: Corgard).
Losing weight, if you are overweight
Avoiding alcohol
If you have had bleeding from varices or are likely to have bleeding, your doctor can do a procedure during an endoscopy called "variceal band ligation." This means that the doctor will place small rubber bands around the varices to prevent bleeding. You will need to take medicines that lower the amount of acid in your stomach while the varices heal. Your doctor will tell you what medicine to take. Some of the medicines are available over-the-counter and include:
Omeprazole (sample brand name: Prilosec)
Esomeprazole (sample brand name: Nexium)
Lansoprazole (sample brand name: Prevacid)
Pantoprazole (sample brand name: Protonix)
Variceal band ligation has to be repeated every 2 to 8 weeks until the varices are gone. Rarely, people who have severe bleeding need to have a procedure called a "TIPS." For this procedure, a doctor inserts a thin tube through a vein in the neck and places the tube inside the liver. The tube helps blood to flow through the liver more easily. This lowers the blood pressure in the varices and helps stop bleeding.
Can esophageal varices be prevented? — Treating the underlying liver disease that caused the cirrhosis might help prevent varices.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 17197 Version 9.0
Release: 28.2.2 - C28.105
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