Patient education: Esophageal varices (The Basics)

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 1 of more of these symptoms, call for an ambulance (in the US and Canada, call 9-1-1). Do not drive yourself to the hospital or have another person drive you.

Is there a test for esophageal varices? — Yes. Doctors can use 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 of your body. A doctor then looks for any problems in the photos.

If you do not have varices that are at risk for bleeding, you will probably 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).

●Treating your liver disease

●Avoiding alcohol

If you have had bleeding from varices or are likely to have bleeding, your doctor might recommend a procedure called "variceal band ligation." They can do this during an endoscopy. 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 are available over-the-counter, such as:

●Omeprazole (sample brand name: Prilosec)

●Esomeprazole (sample brand name: Nexium)

●Lansoprazole (sample brand name: Prevacid)

●Pantoprazole (sample brand name: Protonix)

Variceal band ligation is usually repeated every 2 to 8 weeks until the varices are gone.

Some people with severe bleeding need to have a procedure called a "TIPS." For this, a doctor inserts a thin tube through a vein in the neck and places the tube inside the liver. The tube helps blood 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.

More on this topic

Patient education: Cirrhosis (The Basics)
Patient education: Upper endoscopy (The Basics)
Patient education: Liver panel (The Basics)

Patient education: Esophageal varices (Beyond the Basics)
Patient education: Cirrhosis (Beyond the Basics)