What is variceal bleeding?

Variceal bleeding happens when large veins get swollen and break open. This can happen in the esophagus, stomach, and rectum. It's caused by a condition called portal hypertension. This is high pressure in the veins that filter blood from the intestines through the liver.

Having enlarged veins (varices) usually causes no symptoms.

Varices may be found during an endoscopy exam of the esophagus.

Treatment may include procedures and medicines. These help to cut off blood flow through the vein and lower pressure in the vein. It's common for bleeding to come back. You may need to have the procedure several times to control the varices and prevent bleeding.

Having enlarged veins (varices) may not cause any symptoms until the varices bleed. Symptoms may depend on the size of the varices and the pressure in the veins.

Treatment includes endoscopic therapy (variceal banding or sclerotherapy) and medicines. In banding, a rubber ring is placed around the enlarged vein. In sclerotherapy, medicine is injected into the enlarged vein to cut off blood flowing through it. Medicines may be used to constrict blood vessels and lower pressure in the veins.

Endoscopic therapy is the method most commonly used to treat active variceal bleeding in the esophagus. Variceal bleeding occurs when pressure increases in the portal vein system and the veins in the esophagus enlarge to help blood flow through the liver. It also may be used to prevent recurrent episodes of variceal bleeding, which are common.

The two forms of endoscopic therapy are:

• Endoscopic variceal banding (also called ligation).
• Endoscopic sclerotherapy.

Endoscopic therapy is usually used along with medicines taken regularly, such as beta-blockers and vasoconstrictors.

Endoscopic variceal banding (or ligation)

During variceal banding, a doctor uses an endoscope to place an elastic ring that looks like a rubber band around an enlarged vein (varice). Banding the vein in this manner will cut off blood flow through the vein. It may be hard to use this procedure while someone is actively bleeding, because the device used to place the bands blocks the doctor's vision.

​

Variceal banding is often done several times to control the varices and prevent bleeding. For example, banding might be repeated every 2 to 4 weeks for 3 to 4 sessions. Your doctor will check the varices regularly.

Endoscopic sclerotherapy

During endoscopic sclerotherapy, a chemical called a sclerosant is injected directly into an enlarged vein or into the wall of the esophagus next to the enlarged veins. The substance causes inflammation of the inside lining of the vein. Over time this causes the vein to close off and scar. When the vein is closed off, blood cannot flow through it.

Having enlarged veins (varices) usually causes no symptoms. But they may be found during an endoscopy exam of the esophagus.

Endoscopic screening for varices is recommended for anyone who has been diagnosed with cirrhosis. If your first test does not find any varices, you can be tested again in 2 to 3 years. 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.

Vasoconstrictor medicines are used to treat sudden (acute) bleeding from enlarged veins (varices). They make small blood vessels constrict, which reduces blood flow to veins that carry blood to the liver (portal veins).

These medicines also may be used along with endoscopic treatment.

Don't drink alcohol. It increases your risk of bleeding. Eat a variety of healthy foods like fruits, vegetables, whole grains, and lean protein. Stay at a healthy weight. Or if you need to, slowly get to a healthy weight. Rest when you feel tired.

The more severe the liver damage is and the larger the varices (enlarged veins) are, the greater your risk is for variceal bleeding.

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. The chances gradually go down over the next 6 weeks. If varices are not treated, bleeding can lead to death.

Variceal bleeding happens when large veins get swollen and break open. It can happen in the esophagus, stomach, or rectum. As pressure in these veins goes up, the veins become larger and the vein walls become thinner. This causes them to break open and bleed.