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Overview

What Are Oesophageal Varices?

Oesophageal varices are enlarged, fragile veins in the lower oesophagus, the tube that carries food to the stomach. They usually develop when increased pressure in the portal venous system redirects blood around a diseased or blocked liver. Varices may cause no symptoms until they start to bleed. Bleeding can be life-threatening because it may lead to rapid blood loss, especially in people with advanced liver disease.

Emergency Warning Signs

Emergency Warning Signs

Get urgent help

Possible variceal bleeding is an emergency

If you have known or suspected oesophageal varices and develop any sign of bleeding, call emergency services immediately. Do not wait for symptoms to settle.

  • Vomiting blood or material that looks like coffee grounds
  • Passing black, tarry stools
  • Fainting or severe dizziness
  • Confusion
  • Pale, clammy skin
  • A rapid heartbeat

Do not drive yourself to hospital. Emergency clinicians may need to stabilise your circulation, replace lost blood or fluids, and control bleeding urgently. These signs can indicate bleeding varices or an oesophagus varices rupture.

Symptoms

Symptoms of Oesophageal Varices

Unbleeding oesophageal varices usually cannot be felt and may be discovered while a person is being monitored for liver disease or portal hypertension. Symptoms generally begin when bleeding starts and can become severe quickly.

  • Vomiting blood (haematemesis)
  • Passing black, tarry stools (melaena)
  • Light-headedness
  • Fainting
  • Weakness
  • Confusion
  • Shortness of breath

Causes

Causes of Oesophageal Varices

Portal hypertension means that blood pressure is increased in the portal venous system, which carries blood from the digestive organs to the liver. When a scarred or damaged liver resists blood flow, blood is diverted through smaller collateral veins, including veins in the oesophagus. These veins are not designed to carry such high pressure, so they can enlarge and bleed. The same pressure changes may also contribute to gastric varices, which form in the stomach.

  • Cirrhosis and advanced liver scarring can increase resistance to blood flow through the liver.
  • Chronic viral hepatitis can cause ongoing liver inflammation and scarring.
  • Alcohol-related liver disease can damage the liver and lead to portal hypertension.
  • Metabolic dysfunction-associated steatotic liver disease can progress to advanced scarring and cirrhosis.
  • Portal vein thrombosis can obstruct blood flow and raise pressure in the portal venous system.
  • Less common conditions affecting the liver, portal vein, or blood vessels can also cause portal hypertension and varices.

Risk Factors

Risk Factors for Oesophageal Varices

Conditions and factors that increase risk

  • Cirrhosis or advanced liver disease is a major underlying risk factor and cannot usually be reversed once established.
  • Previous oesophageal or gastric variceal bleeding increases the risk of another bleed.
  • Portal or splenic vein thrombosis can obstruct blood flow and raise portal pressure.
  • Heavy alcohol use can worsen liver injury, although reducing or stopping alcohol may lower further risk.
  • Chronic hepatitis B or hepatitis C infection can cause liver inflammation and scarring; testing and treatment may be possible.
  • Obesity and metabolic disease can contribute to fatty liver disease and may be improved with tailored medical support.
  • A history of portal hypertension complications indicates more advanced disease and requires specialist follow-up.

Complications

Complications of Oesophageal Varices

  • Severe blood loss
  • Low blood pressure and circulatory shock
  • Anaemia
  • Aspiration of blood into the lungs
  • Recurrent variceal bleeding
  • Kidney injury
  • Worsening liver failure

The risk of complications depends on whether bleeding has occurred, how severe the portal hypertension is, and the health of the liver and other organs. A rupture or major bleed from oesophageal varices is an emergency and can cause life-threatening shock, while repeated bleeding may worsen anaemia and overall health.

Diagnosis

How Oesophageal Varices Are Diagnosed

Upper gastrointestinal endoscopy is the main test for directly seeing oesophageal varices. It allows clinicians to assess their size and appearance, look for signs of recent or active bleeding, and sometimes treat them during the same procedure.

  • Upper gastrointestinal endoscopy to view and sometimes treat the varices
  • Blood tests to check anaemia, clotting, and liver function
  • Ultrasound with Doppler to assess blood flow and portal hypertension
  • CT or MRI imaging when more detail about the liver or blood vessels is needed
  • Urgent endoscopy during suspected active bleeding

Treatment & Management

Treatment and Management of Oesophageal Varices

Emergency treatment for active bleeding

Active bleeding is a medical emergency and is treated in hospital with resuscitation and medicines that reduce portal pressure, as chosen by the treating team. Urgent endoscopic band ligation places small bands around bleeding or high-risk veins to stop the bleeding; this procedure is also known as banding of the esophageal varices or endoscopic band ligation for esophageal varices. If bleeding cannot be controlled, specialist options may include a transjugular intrahepatic portosystemic shunt (TIPS), balloon tamponade as a temporary measure, or other interventions.

Preventing a first or recurrent bleed

For people with large varices or those who have already had a bleed, the aim is to lower the risk of future bleeding. This may involve medicines that reduce pressure in the portal vein, such as non-selective beta blockers, and repeat banding sessions until the varices are eradicated. Long-term care also focuses on treating the underlying liver disease, taking prescribed medicines as directed, attending scheduled endoscopic surveillance, and repeating banding when needed.

Prevention

Can Oesophageal Varices Be Prevented?

  • Avoid alcohol or follow an agreed alcohol-reduction plan
  • Prevent, test for, and treat viral hepatitis when appropriate
  • Manage weight, diabetes, and other metabolic conditions
  • Take prescribed medicines that reduce portal pressure as directed
  • Ask a clinician before taking medicines that may increase bleeding risk
  • Attend recommended liver reviews and endoscopy appointments

Outlook and Prognosis

Outlook and Prognosis

Unbleeding oesophageal varices may remain stable with appropriate treatment and monitoring. A rupture or major bleed requires urgent care and carries a significant risk of recurrence, so new bleeding symptoms should always be treated as an emergency.

What affects life expectancy?

Life expectancy for a person with esophageal varices cannot be predicted from varices alone. Outlook depends on liver function, the cause and severity of portal hypertension, general health, whether bleeding has happened before, and how quickly any bleeding is treated. Ongoing specialist follow-up, taking medicines as prescribed, repeat endoscopy when advised, and treating the underlying liver disease can help reduce risk and support long-term management.