Oesphageal Varices

What are oesophageal varices?

Oesophageal varices are similar to varicose veins, but they appear inside the oesophagus, which is the tube that passes from the mouth into the stomach. They can also occasionally appear in the stomach.

A ‘varix’ is a part of a vein that has become enlarged and has thin walls. Varices (the plural of varix) means there is a group of veins that are swollen and have thin walls.

In a person with a normal liver, blood coming from the intestines reaches the liver though a special set of veins called the portal system. In someone with a damaged liver, blood can’t flow normally through these veins. Pressure begins to build up in the veins of the liver, as well as those in the oesophagus and stomach. Oesophageal varices form.

These varices have thin walls and often rupture, causing bleeding. Lifting heavy objects, straining, sneezing, coughing and vomiting can all cause the varices to tear, as well as poorly chewed food and irritation from stomach acid.

Signs and symptoms of oesophageal varices

Often the first sign of a person having oesophageal varices is when they burst and cause bleeding. If the bleeding is mild, it may appear in the bowel motion (stool) as a red or black colour. When bleeding is severe, it may cause vomiting of bright red blood.

How are oesophageal varices treated?

Treatment for oesophageal varices begins with finding where the bleeding is coming from. The most common way of doing this is to use endoscopy – a procedure where a tube with a tiny camera at one end is passed into the oesophagus to see inside. Once the varices have been found, the endoscope can be used to attach small rubber bands to stop the bleeding.

If the rubber bands can’t control the bleeding, this becomes a life threatening condition. As a temporary measure, such as if the person needs to be transferred to a larger hospital, a procedure may be done in which a special balloon on a tube is passed down the oesophagus and inflated, so it presses on the varices to stop the bleeding.

A longer term solution is to do a procedure called a transjugular intrahepatic portosystemic shunt, or TIPS . In this operation, a metal opening device is placed in the liver, connecting the hepatic and portal veins and allowing blood to flow freely.

What happens in Intensive Care?

Someone with severely bleeding oesophageal varices may need to be admitted to an Intensive Care Unit ( ICU ). In the ICU :

  • a monitor will be used to closely observe their pulse, blood pressure and heart activity
  • various sterile tubes may be inserted – one into the bladder to check the kidneys are working properly, one into an artery in the arm to measure changes in blood pressure, and another into a large vein to check how much blood has been lost
  • oxygen may be given via an oxygen mask, or in some cases, using an endotracheal tube (breathing tube) and ventilator (breathing machine)
  • frequent blood tests will be done, and blood products replaced as required
  • medications such as terlipressin or vasopressin may be given to help reduce pressure in the liver
  • a blood transfusion may be given.

The time spent in the ICU can vary from a few days to weeks, depending on the severity of liver disease, the amount of bleeding, and other factors.

Most people treated for bleeding varices survive, and in some cases it may be possible to partially reverse the liver damage. However, bleeding varices can be just one consequence of a failing liver, and some people may go on to become jaundiced or even unconscious. In some circumstances, liver transplantation may be required.

Publication details

Oesphageal varices, version 2. Marghie Murgo, Patient safety officer, Clinical Excellence Commission. April 2016.

Disclaimer

The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.