Esophageal Varices: Causes, Symptoms & Treatment Options

Esophageal varices are dilated, tortuous veins in the distal esophagus caused by portal hypertension—elevated pressure in the portal venous system draining the gut and spleen.

Common Causes

• Cirrhosis (most common)
• Portal vein thrombosis
• Schistosomiasis
• Hepatic vein obstruction (Budd-Chiari)
• Liver cancer with vascular invasion

Symptoms

Often asymptomatic until rupture. Warning signs of portal hypertension:

• Hematemesis (vomiting blood) or melena (black tarry stools) – medical emergency
• Dysphagia (difficulty swallowing)
• Chest pain
• Ascites, leg edema (signs of advanced liver disease)

Treatment

• Primary prophylaxis: Non-selective beta-blockers (propranolol, nadolol) or endoscopic band ligation (EBL) to prevent first bleed
• Acute bleed: Vasoactive drugs (terlipressin, octreotide), antibiotic prophylaxis, urgent EBL or sclerotherapy, TIPS (transjugular intrahepatic portosystemic shunt) for refractory cases
• Secondary prophylaxis: Beta-blockers + EBL surveillance
• Definitive: Liver transplant for end-stage cirrhosis

Prognosis

Variceal bleed carries 15–20% mortality per episode. Long-term survival depends on liver function (Child-Pugh/MELD score) and bleed control.