BACK TOTOP Browse A-ZSearchBrowse A-ZABCDEFGHIJKLMNOPQRSTUVWXYZ0-9 E-mail FormEmail ResultsName:Email address:Recipients Name:Recipients address:Message: Print-FriendlyBookmarksbookmarks-menuBleeding esophageal varicesLiver cirrhosis - varices; Cryptogenic chronic liver disease - varices; End-stage liver disease - varices; Alcoholic liver disease - varices; NASH varices; Alcoholic hepatitis - varicesThe esophagus (food pipe) is the tube that connects your throat to your stomach. Varices are enlarged veins that may be found in the esophagus in people with cirrhosis of the liver. These veins may rupture and bleed. Causes Scarring (cirrhosis) of the liver is the most common cause of esophageal varices. This scarring cuts down on blood flowing through the liver. As a result, more blood flows through the veins of the esophagus.CirrhosisCirrhosis is scarring of the liver and poor liver function. It is the last stage of chronic liver disease.ImageRead Article Now Book Mark Article The extra blood flow causes the veins in the esophagus to balloon outward. Heavy bleeding can occur if the veins tear.Any type of long-term (chronic) liver disease can cause esophageal varices.Varices can also occur in the upper part of the stomach. Symptoms People with chronic liver disease and esophageal varices may have no symptoms.If there is only a small amount of bleeding, the only symptom may be dark or black streaks in the stools.If larger amounts of bleeding occur, symptoms may include:Black, tarry stools Bloody stools Lightheadedness LightheadednessDizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...ImageRead Article Now Book Mark Article Paleness Symptoms of chronic liver disease Vomiting bloodVomiting bloodVomiting blood is regurgitating (throwing up) contents of the stomach that contains blood. Vomited blood may appear bright red, dark red, or look lik...Read Article Now Book Mark Article 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 Low blood pressureLow blood pressure occurs when blood pressure is much lower than normal. This means the heart, brain, and other parts of the body do not get enough ...Read Article Now Book Mark Article Rapid heart rate Rapid heart rateA bounding pulse is a strong throbbing felt over one of the arteries in the body. It is due to a forceful heartbeat.ImageRead Article Now Book Mark Article Signs of chronic liver disease or cirrhosisTests 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. EGDEsophagogastroduodenoscopy (EGD) is a test to examine the lining of the esophagus, stomach, and first part of the small intestine (the duodenum)....ImageRead Article Now Book Mark Article Insertion of a tube through the nose into the stomach (nasogastric tube) to look for signs of bleeding.Some providers suggest EGD for people who are newly diagnosed with mild to moderate cirrhosis. This test screens for esophageal varices and treats them before there is bleeding. Treatment The goal of treatment is to stop acute bleeding as soon as possible. Bleeding must be controlled quickly to prevent shock and death.AcuteAcute means sudden or severe. Acute symptoms appear, change, or worsen rapidly. It is the opposite of chronic.ImageRead Article Now Book Mark Article ShockShock is a life-threatening condition that occurs when the body is not getting enough blood flow. Lack of blood flow means the cells and organs do n...ImageRead Article Now Book Mark Article If massive bleeding occurs, a person may need to be put on a ventilator to protect their airway and prevent blood from going down into the lungs.To stop the bleeding, the provider may pass an endoscope (tube with a small light at the end) into the esophagus:Endoscope An endoscope is a medical device with a light attached. It is used to look inside a body cavity or organ. The scope is inserted through a natural o...Read Article Now Book Mark Article A clotting medicine may be injected into the varices. A rubber band may be placed around the bleeding veins (called banding).Other treatments to stop the bleeding:A medicine to tighten blood vessels may be given through the vein. Examples include octreotide or vasopressin. Tighten blood vesselsVasoconstriction is the narrowing (constriction) of blood vessels by small muscles in their walls. When blood vessels constrict, blood flow is slowe...ImageRead Article Now Book Mark Article VasopressinAntidiuretic blood test measures the level of antidiuretic hormone (ADH) in blood.Read Article Now Book Mark Article Rarely, a tube may be inserted through the nose into the stomach and inflated with air. This produces pressure against the bleeding veins (balloon tamponade).Once the bleeding is stopped, other varices can be treated with medicines and medical procedures to prevent future bleeding. These include:Drugs called beta blockers, such as propranolol and nadolol that reduce portal vein pressure and the risk of bleeding. A rubber band can be placed around the bleeding veins during an EGD procedure. Also, some medicines can be injected into the varices during EGD to cause them to clot. Transjugular intrahepatic portosystemic shunt (TIPS). This is a procedure to create new connections between two blood vessels in your liver. This can decrease pressure in the veins and prevent bleeding episodes from happening again.TIPSTransjugular intrahepatic portosystemic shunt (TIPS) is a procedure to create new connections between two blood vessels in your liver. You may need ...ImageRead Article Now Book Mark Article In rare cases, emergency surgery may be used to treat people if other treatment fails. Portacaval shunts or surgery to reduce the pressure in the esophageal varices are treatment options, but these procedures are risky.People with bleeding varices from liver disease may need more treatment for their liver disease, including a liver transplant. Outlook (Prognosis) Bleeding often comes back with or without treatment.Bleeding esophageal varices are a serious complication of liver disease and have a poor outcome. Placement of a shunt can lead to decrease of blood supply to the brain. This can lead to mental status changes. Possible Complications Future problems caused by varices may include:Narrowing or stricture of the esophagus due to scarring after a procedure Stricture of the esophagusBenign esophageal stricture is a narrowing of the esophagus (the tube from the mouth to the stomach). It causes swallowing difficulties. Benign mean...ImageRead Article Now Book Mark Article Return of bleeding after treatment When to Contact a Medical Professional Contact your provider or go to an emergency room if you vomit blood or have black tarry stools. Prevention Treating the causes of liver disease may prevent bleeding. Liver transplantation should be considered for some people.Open ReferencesReferencesGarcia-Tsao G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 144.Savides TJ, Jensen DM. Gastrointestinal bleeding. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 20.AllVideoImagesTogDigestive system - illustration The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.Digestive systemillustrationLiver blood supply - illustration The proper hepatic artery supplies blood to the liver.Liver blood supplyillustrationDigestive system - illustration The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.Digestive systemillustrationLiver blood supply - illustration The proper hepatic artery supplies blood to the liver.Liver blood supplyillustrationRelated Information Liver disease(Condition)Black or tarry stools(Symptoms)Shock(Injury)Hypovolemic shock(Condition)Esophageal stricture – benign(Condition)Cirrhosis - discharge(Discharge) Review Date: 10/25/2021 Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- © 1997- All rights reserved. A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.Content is best viewed in IE9 or above, Firefox and Google Chrome browser.