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Bleeding esophageal varices

• Overview
• Symptoms
• Treatment
• Prevention

Treatment:

The goal of treatment is to stop acute  bleeding as soon as possible, and treat persistent varices with medicines and medical procedures. Bleeding must be controlled quickly to prevent shock and death. If massive bleeding occurs, the patient may be placed on a ventilator to protect the airway and prevent blood from going down into the lungs.

In endoscopic therapy, an endoscope is used. The health care provider may inject the varices directly with a clotting medicine, or place a rubber band around the bleeding veins. This procedure is used in acute bleeding episodes and as prophylactic (preventive) therapy.

Acute bleeding may also be treated by a balloon tamponade -- a tube that is inserted through the nose into the stomach and inflated with air to produce pressure against the bleeding veins.

In the transjugular intrahepatic portosystemic shunt (TIPS) procedure, a catheter is extended through a vein across the liver where it connects the portal blood vessels to the regular veins in the body, and decreases pressure in the portal vein system .

Octreotide and vasopressin are medications that may be used to decrease portal blood flow and slow bleeding.

Emergency surgery may be used (rarely) treat patients if other therapy fails. Portacaval shunts or surgical removal of the esophagus are two treatment options, but these procedures have a high death rate.

Expectations (prognosis):

Bleeding recurs frequently without treatment. Bleeding esophageal varices are a serious complication of liver disease and carry a poor prognosis (probable outcome). Liver transplantation should be considered for patients with bleeding varices from liver disease.

Complications:

• Recurrence of bleeding after treatment
• Hypovolemic shock
• Esophageal stricture after surgery or endoscopic therapy
• Worsening encephalopathy (confusion)
• Infection (pneumonia, blood stream infection, peritonitis)

Calling your health care provider:

Call your health care provider if significant episodes of vomiting blood or black tarry stools occur.

• Review Date: 5/4/2006
• Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Jefferson Health System, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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