In people who have cirrhosis, high blood pressure in the veins that carry blood from the intestines to the liver (portal hypertension) causes many problems. One serious complication of portal hypertension is variceal bleeding.
When blood pressure increases in the portal vein system, veins in the esophagus, stomach, and rectum enlarge to accommodate blocked blood flow through the liver. The presence of enlarged veins (varices) usually causes no symptoms. (They may be found during an endoscopy examination of the esophagus.) About 50 to 60 out of 100 people who have cirrhosis develop varices in the esophagus.footnote 1
As the blood pressure in the portal vein system continues to increase, the walls of these expanded veins become thinner, causing the veins to rupture and bleed. This is called variceal bleeding.
- The more severe the liver damage and the larger the varices, the greater your risk is for variceal bleeding.
- 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 and gradually goes down over the next 6 weeks. If varices are not treated, bleeding can lead to death.
Treatment for variceal bleeding can be challenging and may include medicines as well as endoscopic therapy (endoscopic banding or sclerotherapy). For more information, see:
- Endoscopic Treatment for Variceal Bleeding Caused by Cirrhosis.
- Cirrhosis: Vasoconstrictor Medicines for Variceal Bleeding.
- Cirrhosis: Beta-Blockers for Portal Hypertension and Varices.
The American College of Gastroenterology recommends endoscopic screening for varices for anyone who has been diagnosed with cirrhosis. This recommendation is also followed in Canada. 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.
- 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.
- 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.
Current as of:
February 10, 2021
Author: Healthwise Staff
Adam Husney MD - Family Medicine
Brian D. O'Brien MD - Internal Medicine
W. Thomas London MD - Hepatology
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