Bleeding esophageal varices develop if swollen veins in the lower esophagus ruptures and bleeds. The esophagus is a muscular tube connecting the mouth to the stomach. The veins in the lower esophagus positioned near the stomach become inflamed if the blood flow to the liver is diminished. This might be due to scar tissue or a blood clot inside the liver.
Once the blood flow in the liver is obstructed, blood accumulates in the other neighboring blood vessels including in the lower esophagus. Nevertheless, these veins are relatively smaller and not capable of supporting large amounts of blood. Due to the increased blood flow, they dilate and become swollen.
The swollen veins are called as esophageal varices that might leak blood and rupture. This results to significant bleeding and dangerous complications including death. This is considered as a medical emergency.
Esophageal varices are not likely to trigger any symptoms unless they rupture. Once this occurs, the following might arise:
- Stomach pain
- Black stools
- Lightheadedness or loss of consciousness
- Blood-streaked stools
Call for emergency assistance or bring the individual to the nearest emergency department if any of these symptoms are present.
What are the risk factors?
Esophageal varices are likely to rupture if the individual has:
- Large-sized esophageal varices
- Portal hypertension
- Red-colored marks on the esophageal varices seen during endoscopy
- Bacterial infection
- Severe cirrhosis
- Excessive consumption of alcohol
- Excessive vomiting
- Severe episodes of coughing
The main objective of treatment is to prevent the esophageal varices from rupturing and bleeding.
Controlling portal hypertension
The initial step in reducing the risk for bleeding is to control portal hypertension. This is achieved with the following:
- Beta-blockers to lower the blood pressure such as propranolol
- Endoscopic sclerotherapy involves using an endoscope to inject medication into the swollen veins to shrink them
- Endoscopic variceal ligation involves using an endoscope to secure the swollen veins using an elastic band to stop bleeding. These bands are removed after a few days.
Bleeding has started
Both endoscopic variceal ligation and sclerotherapy are used if the esophageal varices are bleeding. The doctor might utilize the medication octreotide to reduce the pressure in the engorged veins by constricting the blood vessels and lowering the blood flow.
Other treatment options that are used include:
- Transjugular intrahepatic portosystemic shunt procedure
- Distal splenorenal shunt procedure
In rare instances, the individual might require a liver transplant.