Patient education: Esophageal varices (The Basics)

What are esophageal varices? — 

These 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? — 

They 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 lets the doctor see inside your esophagus, stomach, and the first part of your intestine.

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.

Can bleeding from varices be prevented? — 

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), nadolol (brand name: Corgard), and carvedilol (brand name: Coreg).

●Treating your liver disease

If you have varices that are at risk for bleeding but you cannot take beta blockers, 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. They will do another endoscopy a few weeks later to see if more bands are needed.

What can I do on my own? — 

To lower the risk of bleeding and protect your liver, you should:

●Avoid alcohol – If you are having trouble stopping drinking, your doctor or nurse can help. Avoiding alcohol will also help prevent further liver damage.

●Avoid NSAIDs – These are medicines often used to treat pain or fever. They include aspirin, ibuprofen (sample brand names: Motrin, Advil), and naproxen (sample brand name: Aleve).

●Keep a healthy body weight – If you have excess body weight, losing weight can help prevent further liver damage. Your doctor or nurse can talk to you about how to lose weight in a healthy way.

●Managing your other health conditions – Some people with varices also have other health problems, like diabetes, high blood pressure, or high cholesterol. Treating these problems can help protect your liver, too.

Can varices be prevented? — 

Treating the underlying liver disease that caused the cirrhosis might help prevent varices from forming.

More on this topic

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

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