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Definition Return to top
Bleeding esophageal varices result from dilated veins in the walls of the lower part of the esophagus and sometimes the upper part of the stomach.Causes, incidence, and risk factors Return to top
Bleeding varices are a life-threatening complication of portal hypertension (increased blood pressure in the portal vein caused by liver disease). Increased pressure causes the veins to balloon outward. The vessels may rupture, causing vomiting of blood and bloody stools or tarry black stools. If a large volume of blood is lost, signs of shock will develop. Any cause of chronic liver disease can cause bleeding varices.
Symptoms Return to top
Signs and tests Return to top
Physical examination:
Tests to localize bleeding and detect active bleeding include the insertion of a tube through the nose and down into the stomach to look for signs of bleeding (nasogastric or "NG" tube). Tests to visualize the varices include EGD (esophagogastroduodenoscopy).
Treatment Return to top
The objective of therapy is to stop acute bleeding as soon as possible and manage persistent varices with medical and procedural therapies. Bleeding must be controlled quickly to prevent shock and death. If massive bleeding occurs, the patient may be placed on a ventilator to protect the airway and prevent blood from going down into the lungs.
In endoscopic therapy, an endoscope (a device with a light that can look inside of a body cavity) is used. The health care provider may directly inject the varices with a clotting agent or place a rubber band around the bleeding veins. This procedure is used in acute bleeding episodes and as prophylactic (preventive) therapy.
Acute bleeding may also be treated by a balloon tamponade -- a tube that is inserted through the nose into the stomach and inflated with air to produce pressure against the bleeding veins.
In the transjugular intrahepatic portosystemic shunt (TIPS) procedure, a catheter is extended through a vein across the liver where it connects the portal system to the systemic venous system and decreases portal venous pressure.
Octreotide and vasopressin are medications that may be used to decrease portal blood flow and slow bleeding.
Emergency surgery may rarely be used to treat patients if other therapy fails. Portacaval shunts that pass blood to the vena cava from the portal vein by a graft or resection of the esophagus are two treatment options, but these procedures have a high death rate.
Expectations (prognosis) Return to top
Bleeding recurs frequently without treatment. Bleeding esophageal varices are a serious complication of liver disease and carry a poor prognosis (probable outcome). Liver transplantation should be considered for patients with bleeding varices from liver disease.
Complications Return to top
Calling your health care provider Return to top
Call your health care provider if significant episodes of vomiting blood or black tarry stools occur.
Prevention Return to top
Treatment of the underlying causes of liver disease may prevent bleeding. Preventive treatment of varices with medications such as beta blockers or with endoscopic banding may be helpful in preventing bleeding. Evaluation for liver transplantation should also be considered.
Update Date: 5/14/2004 Updated by: Christian Stone, M.D., Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, MO. Review provided by VeriMed Healthcare Network.
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Page last updated: 28 October 2004 |