Esophageal varices are abnormally dilated veins in the esophagus that are an important and common complication of liver disease. The term varices is similar to the commonly known “varicose veins” some people get in the legs but is unrelated to this condition. Esophageal varices occur as a complication of cirrhosis of any cause but can occasionally happen in liver disease without cirrhosis.
Varices are the result of portal hypertension: as the liver decompensates and scars in cirrhosis, there is increased resistance of blood flow through the liver. This back-up of blood flow increases the pressure in certain blood vessels upstream of the liver, causing them to increase in size and be prone to bleeding. Identification of esophageal varices in patients with cirrhosis is important because the bleeding can be dramatic and even life threatening.
Until they bleed, varices cause no specific symptoms.
It is therefore important in all patients with cirrhosis to screen for esophageal varices. This is most commonly done with upper endoscopy (EGD). This test allows your doctor to determine if varies are present, classify their severity, and potentially provide endoscopic treatment to prevent bleeding. Should previously undetected varices bleed, the same test can confirm the cause of bleeding and apply endoscopic therapy to stop the bleeding and prevent re-bleeding. If you have significant liver disease, it is important to discuss with your doctor if you need to be screening for esophageal varices.
Treatment of varices includes medication, endoscopic therapy, and transjugular intrahepatic portosystemic shunts (TIPS). Medications (termed “beta-blockers” may be prescribed to decrease the pressure in the blood vessels and prevent bleeding. Endoscopic therapy of varices includes band ligation (aka “banding”) or injection of medication. Banding is most commonly used and is a technique in which the endoscope is used to deploy a rubber band to strangulate the dilated blood vessel, causing it to eventually clot off and thereby decrease the blood flow and risk of bleeding. Injection therapy involves injection of medication to achieve the same goal, especially when banding is not applicable.