Diagnosis

If you have cirrhosis, your doctor should screen you for esophageal varices when you're diagnosed. How often you'll undergo screening tests depends on your condition. Main tests used to diagnose esophageal varices are:

  • Endoscope exam. A procedure called upper gastrointestinal endoscopy is the preferred method of screening for varices. Your doctor inserts a thin, flexible, lighted tube (endoscope) through your mouth and into your esophagus, stomach and the beginning of your small intestine (duodenum).

    The doctor will look for dilated veins, measure them, if found, and check for red streaks and red spots, which usually indicate a significant risk of bleeding. Treatment can be performed during the exam.

  • Imaging tests. Both abdominal CT scans and Doppler ultrasounds of the splenic and portal veins can suggest the presence of esophageal varices.
  • Capsule endoscopy. In this test, you swallow a vitamin-sized capsule containing a tiny camera, which takes pictures of the esophagus as it goes through your digestive tract. This might be an option for people who are unable or unwilling to have an endoscope exam. This technology is more expensive than regular endoscopy and not as available.

Treatment

The primary aim in treating esophageal varices is to prevent bleeding. Bleeding esophageal varices are life-threatening. If bleeding occurs, treatments are available to try to stop the bleeding.

Treatment to prevent bleeding

Treatments to lower blood pressure in the portal vein may reduce the risk of bleeding esophageal varices. Treatments may include:

  • Medications to reduce pressure in the portal vein. A type of blood pressure drug called a beta blocker may help reduce blood pressure in your portal vein, decreasing the likelihood of bleeding. These medications include propranolol (Inderal, Innopran) and nadolol (Corgard).
  • Using elastic bands to tie off bleeding veins. If your esophageal varices appear to have a high risk of bleeding, your doctor might recommend a procedure called band ligation.

    Using an endoscope, the doctor snares the varices and wraps them with an elastic band, which essentially "strangles" the veins so they can't bleed. Esophageal band ligation carries a small risk of complications, such as scarring of the esophagus.

Treatment if you're bleeding

Bleeding varices are life-threatening, and immediate treatment is essential. Treatments used to stop bleeding and reverse the effects of blood loss include:

  • Using elastic bands to tie off bleeding veins.
  • Medications to slow blood flow into the portal vein. A drug called octreotide (Sandostatin) is often used with endoscopic therapy to slow the flow of blood from internal organs to the portal vein. The drug is usually continued for five days after a bleeding episode.
  • Diverting blood flow away from the portal vein. Your doctor might recommend a procedure called transjugular intrahepatic portosystemic shunt (TIPS) to place a shunt. The shunt is a small tube that is placed between the portal vein and the hepatic vein, which carries blood from your liver to your heart. The shunt reduces pressure in the portal vein and often stops bleeding from esophageal varices.

    But TIPS can cause serious complications, including liver failure and mental confusion, which can develop when toxins that the liver normally would filter are passed through the shunt directly into the bloodstream. TIPS is mainly used when all other treatments have failed or as a temporary measure in people awaiting a liver transplant.

  • Restoring blood volume. You might be given a transfusion to replace lost blood and clotting factor to stop bleeding.
  • Preventing infection. There is an increased risk of infection with bleeding, so you'll likely be given an antibiotic to prevent infection.
  • Replacing the diseased liver with a healthy one. Liver transplant is an option for people with severe liver disease or those who experience recurrent bleeding of esophageal varices. Although liver transplantation is often successful, the number of people awaiting transplants far outnumbers the available organs.

Rebleeding

Bleeding will recur in most people who have bleeding from esophageal varices. Beta blockers and esophageal band ligation are the recommended treatments to help prevent rebleeding.

Preparing for your appointment

You might start by seeing your primary care provider. Or, you may be referred immediately to a doctor who specializes in digestive disorders (gastroenterologist). If you're having signs and symptoms of internal bleeding, you may be told to immediately call 911 or your local emergency number to be taken to the hospital for urgent care.

Here's some information to help you get ready for an appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting before a specific test. Make a list of:

  • Your symptoms, including any that seem unrelated to the reason for your appointment
  • Key personal information, including major stresses, recent life changes or recent travels, family and personal medical history, and your alcohol use
  • All medications, vitamins or other supplements you take, including doses
  • Questions to ask your doctor.

Take a family member or friend along, if possible, to help you remember information you're given.

For esophageal varices, questions to ask your doctor include:

  • What's likely causing my symptoms?
  • What other possible causes are there?
  • What tests do I need?
  • What's the best course of action?
  • What are the side effects of the treatments?
  • Are my symptoms likely to recur, and what can I do to prevent that?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions that I need to follow?
  • Should I see a specialist?
  • Are there brochures or other printed materials I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

  • When did your symptoms begin?
  • Have your symptoms stayed the same or gotten worse?
  • How severe are your symptoms?
  • Have you had signs of bleeding, such as blood in your stools or vomit?
  • Have you had hepatitis or yellowing of your eyes or skin (jaundice)?
  • Have you traveled recently? Where?
  • If you drink alcohol, when did you start and how much do you drink?

What you can do in the meantime

If you develop bloody vomit or stools while you're waiting for your appointment, call 911 or your local emergency number or go to an emergency room immediately.

June 18, 2016
References
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  2. AskMayoExpert. Esophageal and gastric varices. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015.
  3. Sanyal AJ, et al. Prediction of variceal hemorrhage in patients with cirrhosis. http://www.uptodate.com/home. Accessed Dec. 19, 2015.
  4. LaBrecque D, et al. Global guidelines: Esophageal varices. World Gastroenterology Organisation. www.worldgastroenterology.org/.../esophageal-varices/esophageal-varices-English. Accessed Dec. 19, 2015.
  5. Bajaj JS, et al. Methods to achieve homeostasis in patients with acute variceal hemorrhage. http://www.uptodate.com/home. Accessed Dec. 19, 2015.
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  7. Runyon BA. Patient information: Esophageal varices (beyond the basics). http://www.uptodate.com/home. Accessed Dec. 21, 2015.
  8. Cirrhosis. American Liver Foundation. http://www.liverfoundation.org/abouttheliver/info/cirrhosis/. Accessed Dec. 21, 2015.