Variceal Bleeding as a Complication of Cirrhosis
Topic Overview
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% of people who have cirrhosis develop varices in
the esophagus.1
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.
- The more severe the liver damage and the larger
the varices, the greater your risk is for variceal bleeding.
- Of the
people who develop varices, about 30% have an episode of bleeding within 2
years of the diagnosis of varices.2
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.
References
Citations
- Shah VH, Kamath PS (2006). Portal hypertension
and gastrointestinal bleeding. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease,
8th ed., vol. 2, pp. 1899–1934. Philadelphia: W.B.
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.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
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| Specialist Medical Reviewer | W. Thomas London, MD - Hepatology |
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| Last Revised | May 25, 2010 |
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Last Revised:
May 25, 2010
Shah VH, Kamath PS (2006). Portal hypertension
and gastrointestinal bleeding. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease,
8th ed., vol. 2, pp. 1899–1934. Philadelphia: W.B.
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.
