Why does cirrhosis cause esophageal varices

If you've been diagnosed with liver disease, ask your doctor about strategies to avoid liver disease complications. To keep your liver healthy:.

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Overview Esophageal varices Open pop-up dialog box Close. Esophageal varices Esophageal varices are enlarged veins in the esophagus. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Sanyal AJ. General principles of the management of variceal hemorrhage.

Accessed Jan. Esophageal and gastric varices. Rochester, Minn. Sanyal AJ, et al. Prediction of variceal hemorrhage in patients with cirrhosis. Jameson JL, et al. Cirrhosis and its complications. In: Harrison's Principles of Internal Medicine. New York, N. Bajaj JS, et al. Methods to achieve homeostasis in patients with acute variceal hemorrhage. Accessed Dec. Merck Manual Professional Version.

Ibrahim M, et al. New developments in managing variceal bleeding. Tayyem O, et al. Evaluation and management of variceal bleeding. Garcia-Tsao G, et al. If blood flow around the liver is restricted, the body sends blood via veins in the stomach or esophagus instead. With more blood flowing through them, these veins can swell, becoming varices. Rarer causes of esophageal varices can include Budd-Chiari syndrome and schistosomiasis. Budd-Chiari syndrome causes veins in the liver to become partially blocked.

Schistosomiasis is a disease caused by parasitic worms. These can get into the blood vessels, which may cause them to become varices. A person with esophageal varices may not have symptoms, particularly if the varices are small.

Some people only experience symptoms if the varices bleed. Symptoms of esophageal varices may include :. A person with liver disease but no cirrhosis has a lower risk of varices. Cirrhosis and portal hypertension are the most common causes of esophageal varices. These are both possible complications of liver disease. The main risk factors for liver disease include :.

A person who has cirrhosis should have regular screening for esophageal varices. To check for these varices, a doctor uses an endoscope , and they may also require a CT scan. Esophageal varices can be small or large. Small varices measure less than 5 millimeters in diameter, and they may require different treatments from larger varices. Small varices do not always cause symptoms. A doctor will recommend ways to prevent further liver damage, which may involve medication and lifestyle changes.

Varices can also form in other areas of the body: Gastric varices occur in the stomach and duodenal varices form in the first part of the small intestine. A person can also develop rectal varices. The main goal of treatment for esophageal varices is to prevent ruptures and bleeding. Initially, this often involves steps to control portal hypertension.

The doctor may prescribe beta-blockers to reduce blood pressure. These drugs work by blocking the effects of a hormone called epinephrine, making the heart beat slower and with less force. Endoscopic sclerotherapy involves using an endoscope to perform minor medical tasks, such as injecting a medication into the swollen veins to make them shrink.

Endoscopic variceal banding involves using the same tool to place a rubber band around a varice to prevent the vessel from bleeding. A doctor may recommend a transjugular intrahepatic portosystemic shunt , or TIPS, procedure. This involves using an X-ray to guide the placement of a small tube to connect the portal vein with the hepatic vein. Placement of a shunt can lead to decrease of blood supply to the brain. This can lead to mental status changes. Treating the causes of liver disease may prevent bleeding.

Liver transplantation should be considered for some people. Liver cirrhosis - varices; Cryptogenic chronic liver disease - varices; End-stage liver disease - varices; Alcoholic liver disease - varices.

Garcia-Tsao G. Cirrhosis and its sequelae. Goldman-Cecil Medicine. Philadelphia, PA: Elsevier; chap Gastrointestinal bleeding. Philadelphia, PA: Elsevier Saunders; chap Updated by: Michael M. Editorial team. Bleeding esophageal varices. Any type of long-term chronic liver disease can cause esophageal varices.

Varices can also occur in the upper part of the stomach. People with chronic liver disease and esophageal varices may have no symptoms. If larger amounts of bleeding occur, symptoms may include: Black, tarry stools Bloody stools Lightheadedness Paleness Symptoms of chronic liver disease Vomiting blood.

Exams and Tests. Your health care provider will do a physical exam which may show: Bloody or black stool in a rectal exam Low blood pressure Rapid heart rate Signs of chronic liver disease or cirrhosis Tests to find the source of the bleeding and check if there is active bleeding include: EGD or upper endoscopy, which involves the use of a camera on a flexible tube to examine the esophagus and stomach.

Insertion of a tube through the nose into the stomach nasogastric tube to look for signs of bleeding. To stop the bleeding, the provider may pass an endoscope tube with a small light at the end into the esophagus: A clotting medicine may be injected into the varices.