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Cirrhosis Complications: Variceal Bleeding

Overview

Variceal bleeding happens when large veins, often in the esophagus, get swollen and break open. It's caused by a condition called portal hypertension. Portal hypertension is high blood pressure in the veins that filter blood from the intestines through the liver (portal system of the liver).

The blood pressure increases in the portal vein system and the veins in the esophagus, stomach, and rectum enlarge to accommodate blocked blood flow through the liver. As the blood pressure in the portal vein system continues to increase, the walls of these expanded veins become thinner, causing veins to rupture and bleed.

What puts you at risk?

The more severe the liver damage is and the larger the varices (enlarged veins) are, the greater your risk is for variceal bleeding.

  • About 50 to 60 out of 100 people who have cirrhosis develop varices in the esophagus.footnote 1
  • Of the people who develop varices, about 30 out of 100 have an episode of bleeding within 2 years of the diagnosis of varices.footnote 2

Variceal bleeding can be a life-threatening emergency. After varices have bled once, there is a high risk of bleeding again. The chance of bleeding again is highest right after the first bleed stops. The chances gradually go down over the next 6 weeks. If varices are not treated, bleeding can lead to death.

How is it diagnosed?

Having enlarged veins (varices) usually causes no symptoms. But they may be found during an endoscopy exam of the esophagus.

The American College of Gastroenterology recommends endoscopic screening for varices for anyone who has been diagnosed with cirrhosis. If your first test does not find any varices, you can be tested again in 2 to 3 years.footnote 2 You may need more frequent testing if you have large varices or have already had an episode of variceal bleeding, even if you are treated for your varices with beta-blockers or variceal banding. Recurrent bleeding is common.

How is it treated?

Treatment for variceal bleeding can be challenging and may include endoscopic therapy as well as medicines.

Two types of endoscopic procedures are:

  • Endoscopic variceal banding. A doctor uses an endoscope to place a rubber ring around the enlarged vein. This will cut off blood flow through the vein.
  • Sclerotherapy. A doctor injects medicine directly into the enlarged vein to close off the vein so blood can't flow through it.

Medicines may include:

  • Vasoconstrictor medicines. They constrict blood vessels and reduce blood flow to the portal vein.
  • Beta-blocker medicines. They lower the blood pressure in the veins.

Related Information

References

Citations

  1. Shah VH, Kamath PS (2010). Portal hypertension and gastrointestinal bleeding. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1489–1516. Philadelphia: Saunders.
  2. Garcia-Tsao G, et al. (2007). Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. American Journal of Gastroenterology, 102(9): 2086–2102.

Credits

Current as of: February 10, 2021

Author: Healthwise Staff
Medical Review:
Adam Husney MD - Family Medicine
W. Thomas London MD - Hepatology