Varices are dilated blood vessels usually in the esophagus or stomach. They cause no symptoms unless they rupture and bleed.

Bleeding from varices is a life-threatening complication of portal hypertension. Portal hypertension is an increase in the pressure within the portal vein (the vein that carries blood from the digestive organs to the liver) due to blockage of blood flow throughout the liver.

This increased pressure in the portal vein causes the development of large, swollen veins (varices) within the esophagus and stomach. The varices are fragile and can rupture easily, resulting in a large amount of blood loss.

The most common cause of portal hypertension is cirrhosis of the liver. Cirrhosis is scarring which accompanies the healing of liver injury caused by hepatitis, alcohol or other less common causes of liver damage. In cirrhosis, the scar tissue blocks the flow of blood through the liver and slows its processing functions.

What Are the Symptoms of Bleeding Varices?

Symptoms of bleeding varices include:

• Vomiting of blood
• Black, tarry or bloody stool
• Low blood pressure
• Rapid heart rate
• Shock (in severe cases)

How Are Bleeding Varices Treated?

Bleeding from varices is a medical emergency and treatment should be immediate. If the bleeding is not controlled quickly, a person may go into shock or die. In severe cases, a person may need to be placed temporarily on a ventilator to prevent the lungs from filling with blood. Aside from the urgent need to stop the bleeding, treatment is also aimed at preventing future bleeding. The following procedures help treat bleeding varices by reducing the pressure in these veins.

• Banding: A procedure performed by a gastroenterologist in which small rubber bands are placed directly over the blood vessels (varices). This will stop the bleeding and eradicate the varices.
• Sclerotherapy: A procedure in which a gastroenterologist directly injects the varices with a blood-clotting solution instead of banding them.
• Transjugular Intrahepatic Portosystemic Shunt (TIPS): A radiological procedure in which a stent (a tubular device) is placed in the middle of the liver. The stent connects the hepatic vein with the portal vein. This procedure is done by placing a catheter through a vein in the neck. It is performed to relieve the high blood pressure that has built up in the liver.
• Distal Splenorenal Shunt (DSRS): A surgical procedure that connects the splenic vein to the left kidney vein in order to reduce pressure in the varices and control bleeding.
• Liver transplant : A liver transplant may be done in cases of end-stage liver disease.
• Devascularization: A surgical procedure that removes the bleeding varices. This procedure is done when a TIPS or a surgical shunt is not possible or unsuccessful in controlling the bleeding.

Can Bleeding Varices Be Prevented?

Treating the underlying cause of bleeding varices can help prevent their recurrence and treating liver disease earlier on may prevent their development. Certain medications including the class of heart drugs called "beta-blockers" may reduce elevated portal pressure and reduce the likelihood of bleeding. Long acting nitroglycerines are also used for this purpose.

Reviewed by the doctors at The Cleveland Clinic Taussig Cancer Center.

Edited by Charlotte E. Grayson, MD, WebMD, April 2004.

Portions of this page copyright © The Cleveland Clinic 2000-2004

sourceLast Editorial Review: 1/31/2005 8:20:38 AM

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