What Is the Main Cause of Esophageal Varices?

Esophageal varices are enlarged veins in the esophagus. The main cause of esophageal varices is liver disease.

Esophageal varices are enlarged veins in the food pipe (esophagus). This condition develops in people with liver disease. The liver is the organ that serves several functions including the removal of toxins from the blood. Liver disease affects the blood flow to the liver due to the presence of a clot or scar in the portal vein or splenic vein. As a result, the pressure in the portal vein shoots up. The portal vein is the vein that delivers blood to the liver.

As the pressure shoots up in the portal vein, the blood is pushed into surrounding blood vessels, including vessels in the esophagus. These blood vessels have a thin wall and cannot hold the extra blood. Hence, the blood vessels of the esophagus expand and swell, which are known as varices. If the extra blood exerts more pressure on the walls of the esophageal vessels, the varices can break open and bleed. Bleeding is an emergency condition, as uncontrolled bleeding can lead to shock and death.

Some of the conditions that can cause esophageal varices include

• Cirrhosis (severe scarring) of liver
• Budd–Chiari syndrome (blockage of certain veins in the liver)
• Schistosomiasis (infection caused by a freshwater parasitic worm)

Esophageal varices don’t show any symptoms until they bleed. When the varices start to bleed, the symptoms include

• Vomiting large amounts of blood
• Loss of consciousness in severe cases
• Black, tarry or bloody stools
• Lightheadedness

These may be the signs of underlying liver disease

• Jaundice (yellowing of skin and eyes)
• Ascites (fluid buildup in your abdomen)
• Bruising or bleeding easily

Any severe liver disease can cause esophageal varices. Some of the most common liver conditions that can lead to esophageal varices include

• Cirrhosis
• Alcoholic liver disease
• Fatty liver disease
• Viral hepatitis

Not every person who has esophageal varices will have bleeding. Some of the factors that may increase the chance of bleeding include

• High portal blood pressure
• Large varices
• Severe liver disease
• Severe alcohol consumption
• Red marks on the varices (when viewed through a flexible tube with camera, i.e., the endoscope)
• Liver failure

The primary goal of the treatment is to prevent bleeding. If bleeding occurs, treatments are available to stop the bleeding.

Treatment to prevent bleeding

The treatment options include

• Medicines to reduce blood pressure, such as propranolol and nadolol
• Elastic bands to tie off bleeding veins

Treatment to stop bleeding

The treatment options include

• Using elastic bands to tie off bleeding veins
• Medicines, such as vasopressin and octreotide, to slow blood flow into the portal vein
• Diverting blood flow away from the portal vein with a procedure called transjugular intrahepatic portosystemic shunt (TIPS)
• Placing pressure on varices with the help of balloon tamponade to stop bleeding
• Restoring blood volume by giving a transfusion
• Preventing infection
• Liver transplant

You can prevent esophageal varices by

• Avoiding alcohol and drug abuse
• Eating a healthy diet
• Maintaining a healthy weight
• Reducing your risk of hepatitis by practicing safe sex, getting vaccinated (hepatitis A and B) and not sharing razors or needles