7/31/2019 Bleeding Esophageal Varices

1/3

Bleeding esophageal varices

Cirrhosis - dischargeBleeding esophageal varices are very swollen veins in the walls of the lower part of the esophagus(the tube that connects your throat to your stomach) that begin to bleed.

Causes

Scarring (cirrhosis) of the liver is the most common cause of esophageal varices. This scarringprevents blood from flowing through the liver. As a result, more blood flows through the veins of theesophagus.

This extra blood flow causes the veins in the esophagus to balloon outward. If these veins breakopen (rupture), they can cause severe bleeding.

Any cause of chronic liver disease can cause varices.

The swollen veins (varices) can also occur in the upper part of the stomach.

Symptoms

People with chronic liver disease and esophageal varices may have no symptoms.

If there is only a small amount of bleeding, the only symptom may be dark or black streaks in thestools.

If larger amounts of bleeding occur, symptoms may include:

Black, tarry stools

Bloody stools

Light-headedness Paleness

Symptoms of chronic liver disease (such as cirrhosis)

Vomiting

Vomiting blood

Exams and Tests

Physical examination:

Bloody or black stool on rectal exam

Low blood pressure

Rapid heart rate

Signs of chronic liver disease or cirrhosis

Tests to determine where the bleeding is coming from and detect active bleeding include:

Esophagogastroduodenoscopy (EGD)

Tube through the nose into the stomach (nasogastric tube) to look for signs of bleeding

http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000290.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000255.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003093.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003117.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003118.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/007278.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003077.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003888.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000255.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003093.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003117.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003118.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/007278.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003077.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003888.htmhttp://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000290.htm

7/31/2019 Bleeding Esophageal Varices

2/3

Some doctors recommend EGD for patients who are newly diagnosed with mild-to-moderatecirrhosis to screen for esophageal varices and treat them before there is bleeding.

Treatment

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 preventshockanddeath.

If massive bleeding occurs, the patient may be placed on a ventilator to protect the airways andprevent blood from going down into the lungs.

Treatments for acute bleeding:

A small lighted tube called anendoscope may be used. The health care provider may injectthe varices directly with a clotting medicine, or place a rubber band around the bleedingveins.

A medication that tightens blood vessels (vasoconstriction) may be used. Examples includeoctreotide orvasopressin.

A tube may be inserted through the nose into the stomach and inflated with air. Thisproduces pressure against the bleeding veins (balloon tamponade).

Once the bleeding is stopped, varices can be treated with medicines and medical procedures toprevent future bleeding:

Drugs called beta blockers, such as propranolol and nadolol, are used to reduce the risk ofbleeding.

A small lighted tube called an endoscope may be used to place a rubber band around thebleeding veins.

Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure to create newconnections between two blood vessels in your liver. This can decrease pressure in the

veins and prevent bleeding episodes from happening again.

Emergency surgery may be used (rarely) to treat patients if other therapy fails. Portocaval shunts orsurgery to remove the esophagus are two treatment options, but these procedures are risky.

Patients with bleeding varices from liver disease may need additional treatment of their liverdisease, including a liver transplant.

Outlook (Prognosis)

Bleeding often comes back without treatment. Bleeding esophageal varices are a seriouscomplication of liver disease and have a poor outcome.

Possible Complications

Encephalopathy (sometimes called hepatic encephalopathy)

Esophageal stricture after surgery or endoscopic therapy

Hypovolemic shock

Infection (pneumonia, bloodstream infection,peritonitis)

Return of bleeding after treatment

http://www.nlm.nih.gov/medlineplus/ency/article/002215.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000039.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000039.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000039.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002360.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002338.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002338.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003702.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003702.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/007210.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000302.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000207.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000167.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001335.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001335.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002215.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000039.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002360.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002338.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003702.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/007210.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000302.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000207.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000167.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001335.htm

7/31/2019 Bleeding Esophageal Varices

3/3

When to Contact a Medical Professional

Call your health care provider or go to an emergency room if you vomit blood or have black tarrystools.

Prevention

Treating the causes of liver disease may prevent bleeding. Preventive treatment of varices withmedications such as beta blockers or with endoscopic banding may help prevent bleeding. Livertransplantation should be considered for some patients.

References

Garcia-Tsao G, Sanyal AJ, Grace ND, Carey WD; Practice Guidelines Committee of AmericanAssociation for Study of Liver Diseases; Practice Parameters Committee of American College ofGastroenterology. Prevention and management of gastroesophageal varices and varicealhemorrhage in cirrhosis.Am J Gastroenterol. 2007;102:2086-2102.

Garcia-Tsao G. Cirrhosis and its sequellae. In: Goldman L, Ausiello D, eds.Cecil Medicine. 23rded. Philadelphia, Pa: Saunders Elsevier; 2007:chap 157.