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Esophageal Varices

  • Cynthia M. Johnson, MA
Publication Type:


Esophageal Varices


Esophageal varices are swollen veins in the lining of the food pipe (esophagus). The esophagus is the tube from the mouth to the stomach.

Swollen veins can sometimes break open and bleed. This needs care right away.

The Esophagus.

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Esophageal varices can happen when blood flow to the liver is blocked. The blockage is often due to scarring from liver disease. Pressure builds in the large vein that brings blood to the liver. This is called portal hypertension. The pressure causes blood to flow into other smaller blood vessels, such as those found in the esophagus. This leads to varices.

This may be caused by:

Risk Factors

Things that raise the risk of esophageal varices are:


Some people have no symptoms. If esophageal varices bleed, the signs may be:

  • Vomiting or coughing up blood that may look like coffee grounds
  • Red, tarry, or very dark stools (poop)
  • Light-headedness
  • Fast heartbeat

The amount of bleeding can vary. It may stop on its own or be more serious. Without fast treatment, severe bleeding can be fatal.


The doctor will ask about symptoms and past health. A physical exam may be done.

The doctor can look at the esophagus with:


The goal is to prevent or stop varices from bleeding. Serious bleeding needs to be stopped as soon as possible. Options are:

  • Medicines to lower blood pressure or cholesterol, which helps:
    • Lower the risk of bleeding, or
    • Slow any bleeding that is happening
  • Procedures such as:
  • Endoscopic band ligation—to tie a band around the varices to prevent or stop bleeding
  • Balloon tamponade to pass a balloon through the nose—to compress bleeding varices
  • Transjugular intrahepatic portosystemic shunting—to connect the portal vein to the hepatic vein using a stent to control bleeding
  • Distal splenorenal shunt—to limit bleeding by connecting the main vein in the spleen to the vein in the left kidney

A liver transplant is the only way to completely cure esophageal varices.


There are no known guidelines to lower the risk of esophageal varices.





  • Acute variceal hemorrhage—treatment. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/acute-variceal-hemorrhage-treatment.
  • Esophageal varices. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/esophageal-varices.
  • Garcia-Tsao G, Abraldes JG, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver diseases. Hepatology. 2017;65(1):310-335.


  • Daniel A. Ostrovsky, MD
Last Updated:

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.