Esophageal Variceal Bleeding

Causes

The most common cause of esophageal varices is cirrhosis, a chronic liver disease that causes scarring of the liver. Other causes of portal hypertension that can lead to EVB include:

• Schistosomiasis (parasitic infection)
• Budd-Chiari syndrome (blocked hepatic veins)
• Non-alcoholic fatty liver disease (NAFLD)
• Alcoholic liver disease
• Blood clots in the portal vein
• Splenic vein thrombosis

Symptoms

Esophageal varices often don’t cause any symptoms until they bleed. Symptoms of EVB can come on suddenly and be life-threatening. They include:

• Vomiting large amounts of bright red blood
• Black, tarry stools
• Lightheadedness or dizziness due to blood loss
• Rapid heart rate
• Weakness
• Loss of consciousness in severe cases

Diagnosis

If you have symptoms of EVB, you will need to see a doctor right away. They will ask you about your medical history and symptoms, and perform a physical exam. Tests to diagnose EVB may include:

• Endoscopy: A thin, flexible tube with a light and camera is inserted down your throat to examine the lining of your esophagus and stomach.
• Upper endoscopy with band ligation: During an endoscopy, your doctor may also be able to treat bleeding varices with a procedure called band ligation. Small rubber bands are placed around the varices to cut off their blood supply and stop the bleeding.
• Blood tests: Blood tests can be done to check for liver function and to see if you are bleeding.

Treatment

Treatment for EVB focuses on two main goals: stopping the bleeding and preventing future bleeding.

• Stopping the bleeding: This may involve medications to lower blood pressure in the portal vein, endoscopic band ligation to tie off the bleeding veins, or balloon tamponade, which involves inserting a balloon into the esophagus to compress the bleeding varices.
• Preventing future bleeding: Medications can be used to lower blood pressure in the portal vein and reduce the risk of future bleeding. In some cases, a procedure called a transjugular intrahepatic portosystemic shunt (TIPS) may be done to create a new pathway for blood to flow from the portal vein to the hepatic vein, bypassing the blockage in the liver.

Complications

EVB is a serious condition with a high mortality rate. Complications of EVB can include:

• Shock from blood loss
• Kidney failure
• Infection
• Re-bleeding

Prevention

The best way to prevent EVB is to treat the underlying condition that is causing portal hypertension. If you have liver disease, it is important to follow your doctor’s treatment plan and avoid alcohol and other substances that can damage your liver.