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Bleeding Esophageal Varices

Alternate Names

  • esophageal variceal rupture
  • esophageal variceal bleeding
  • esophageal variceal hemorrhage
  • Bleeding esophageal varices (varicose veins)

Definition

Esophageal varices are unusually enlarged veins around the esophagus - the tube through which food passes from the throat to the stomach. These veins may sometimes bleed.

What is going on in the body?

Esophageal varices usually form because of a serious liver disease called cirrhosis. Cirrhosis of the liver can interfere with blood circulation. This leads to increased pressure in the veins around the esophagus. Over time, these veins enlarge due to the pressure. When the walls of the veins get stretched too much, the veins can break and allow blood to hemorrhage into the esophagus.

Risks

What are the causes and risks of the condition?

The main cause of bleeding esophageal varices is cirrhosis of the liver. Cirrhosis is a large amount of scar tissue dividing the liver into nodules, which can occur because of long-term alcohol abuse. It can also be caused by viral hepatitis, damage from drugs or medications, inherited disorders, or autoimmune hepatitis.

Prevention

What can be done to prevent the condition?

There are several ways to avoid bleeding esophageal varices. They can be prevented by avoiding liver diseases that are caused by long-term alcohol abuse and viral hepatitis. Many cases of hepatitis can be prevented by:
  • not using intravenous or nasal drugs, dirty tattoo ink or needles, or unclean body piercing
  • following safer sex practices, such as being abstinent until marriage, being faithful to one partner for life (particularly in marriage), and using a condom if you choose to be promiscuous
  • being vaccinated for hepatitis B

Diagnosed

How is the condition diagnosed?

When an episode of bleeding occurs in the gut, a procedure called endoscopy is often done. A small tube, called an endoscope, is placed through the mouth and into the esophagus and stomach. The tube has a light and a camera on the end of it. This allows the doctor to see the inside of the gut to find the cause of bleeding.

Long Term Effects

What are the long-term effects of the condition?

A person with esophageal varices often has serious medical problems due to liver disease. The outcome is generally poor unless a liver transplant is performed. Even after treatment, recurrent bleeding from esophageal varices is common and may lead to death.

Other Risks

What are the risks to others?

There are generally no risks to others unless the person has hepatitis. Hepatitis may be passed on to others through unprotected sex. It may also be passed on by sharing drug needles.

Treatments

What are the treatments for the condition?

A person with bleeding esophageal varices can lose a lot of blood. Blood transfusions are usually required. Other fluids need to be replaced through an intravenous line. Endoscopy is done to make sure that varices are the cause of the bleeding. When they are seen, varices can often be treated immediately using tiny catheters that are passed through the endoscope.
Sometimes medications are given to cause the varices to shrink. In severe cases, surgery or other procedures may be required to stop the bleeding or to relieve pressure on the swollen varices. Liver transplantation is generally the only way to cure esophageal varices.

Side Effects

What are the side effects of the treatments?

Endoscopy and surgery can cause more bleeding, infection, narrowing of the esophagus (a stricture), and sometimes even death. Medications used for variceal bleeding may cause salt imbalances, allergic reactions, low blood pressure, or other side effects. Blood transfusions may cause allergic reactions or infections.

After Treatment

What happens after treatment for the condition?

If the bleeding stops for more than 1 or 2 days and the person recovers, he or she can usually go home from the hospital.

Monitor

How is the condition monitored?

A person with esophageal varices usually requires lifelong monitoring for the varices and liver problems. Complete blood counts (CBCs), blood pressure, and the heart rate are followed to make sure the bleeding has stopped. Liver function tests and physical examination may be used to monitor the condition of the liver. Any new or worsening symptoms should be reported to the healthcare provider.

Sources

Cecil Textbook of Medicine, 1996, Bennett et al.

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