Home > Cirrhosis Complications: Variceal Bleeding
In people who have
cirrhosis, high blood pressure in the veins that carry
blood from the intestines to the liver (portal hypertension) causes many problems. One serious complication of portal
hypertension is variceal bleeding.
When blood pressure increases in the portal vein system, veins in the
esophagus, stomach, and
rectum enlarge to accommodate blocked blood flow
through the liver. The presence of enlarged veins (varices) usually causes no
symptoms. (They may be found during an
endoscopy exam of the
esophagus.) About 50 to 60 out of 100 people who have cirrhosis develop varices in
As the blood pressure in the portal vein system continues to
increase, the walls of these expanded veins become thinner, causing the veins
to rupture and bleed. This is called 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 and gradually goes down over the
next 6 weeks. If varices are not treated, bleeding can lead to death.
Treatment for variceal bleeding can be challenging and may include
medicines as well as endoscopic therapy (endoscopic banding or
sclerotherapy). For more information, see:
The American College of Gastroenterology
recommends endoscopic screening for varices 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.2 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.
Shah VH, Kamath PS (2010). Portal hypertension
and gastrointestinal bleeding. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease,
9th ed., vol. 2, pp. 1489–1516. Philadelphia: Saunders.
Garcia-Tsao G, et al. (2007). Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. American Journal of Gastroenterology, 102(9): 2086–2102.
January 17, 2012
Adam Husney, MD - Family Medicine & W. Thomas London, MD - Hepatology
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