Varicose veins in the esophagus are usually the result of liver cirrhosis. If they bleed, it can be life-threatening. What symptoms then occur?
Varicose veins can form not only in the legs, but also in other areas of the body. The pathological enlargements rarely occur in the veins of the esophagus. Experts then speak of esophageal varices.
The medical term for the esophagus is esophagus. Experts refer to varicose veins as varicosities. Therefore, varicose veins in the esophagus are also called esophageal varices.
Varicose veins in the esophagus are usually found in the lower part of the esophagus. They only become noticeable when they bleed. Otherwise, those affected do not feel any symptoms.
Healthy people usually do not have to worry about having varicose veins in the esophagus. Rather, esophageal varices are due to an existing disease.
Esophageal varices are almost always the result of advanced liver disease in which the liver becomes increasingly scarred. People with alcohol-related liver cirrhosis are particularly at risk. About half of all people who are diagnosed with liver cirrhosis already have varicose veins in their esophagus at this point.
Due to liver damage, the so-called portal vein has poorer blood flow. The portal vein is a large vein. It transports nutrient-rich blood from organs such as the intestines and spleen to the liver. However, if the liver tissue is scarred, the blood flow from the portal vein to the liver is disrupted. The blood pools and the pressure in the portal vein increases.
Experts call increased portal pressure portal hypertension.
As a result, the blood takes a different route. It then no longer flows into the heart via the liver, but via newly created bypass circuits. One of them leads into the vessels of the esophagus.
However, compared to the portal vein, the vessels of the esophagus are less suitable for carrying larger amounts of blood. Due to the increased blood flow and the associated high pressure, the veins can easily expand pathologically, resulting in varicose veins.
Varicose veins in the esophagus rarely have causes other than liver cirrhosis. These include other diseases that worsen blood circulation in the liver. A blood clot in the portal vein or veins of the liver or spleen can also cause esophageal varices. Another possible cause is secondary tumors (metastases) in the liver as a result of cancer.
The vessel walls of the esophagus become very thin due to the high pressure. This means they can easily burst and bleed. It is estimated that one in three people with varicose veins in the esophagus will experience at least one bleed over time. The larger the varicose vein and the more severe the liver damage, the greater the risk.
Heavy bleeding causes anemia and arterial blood pressure drops, which can lead to dizziness and weakness and even cardiovascular failure. Out of 100 people with bleeding, 15 to 20 die. If there are signs of bleeding, it is important to act quickly.
Anyone who has been diagnosed with liver cirrhosis should, to be on the safe side, have an esophagoscopy and gastroscopy carried out: The doctor inserts an examination instrument through the mouth. This examination makes it easy to determine whether esophageal varices have formed. If liver cirrhosis has progressed, regular check-ups are recommended.
Esophageal variceal bleeding is a medical emergency that requires hospital treatment. If you suspect something, it is important to call the emergency services (112) immediately.
A sign of a bleeding varicose vein in the esophagus is gushing vomiting of blood. Vomiting blood occurs when a lot of blood gets into the stomach, making the person feel sick.
If the blood reaches the intestine, it turns black due to bacteria. As a result, the stool may appear deep black after a delay.
Heavy bleeding can result in circulatory shock. Possible signs then include:
- dizziness
- Feeling of weakness
- Sweats
- rapid pulse
- low blood pressure
- Loss of consciousness
Treat bleeding immediately
In the case of esophageal variceal bleeding, it is first important to stabilize the person’s circulation. The doctor can tie off bleeding varicose veins with rubber rings or (rarely) destroy them during an esophagoscopy and gastroscopy. Additionally, medications can lower the pressure in the portal vein, which reduces bleeding.
If the bleeding cannot be stopped, special tubes (stents) or compression probes can help. Antibiotics can also be used to prevent bacterial infections.
If a person has varicose veins in the esophagus, certain medications from the group of so-called selective beta blockers can be considered. These include the active ingredients propanolol and carvedilol. They lower the blood pressure in the portal vein – and subsequently also in the stomach and esophagus – and thus reduce the risk that the esophageal varices become stronger and bleed.
Alternatively, severely developed esophageal varices can be ligated during a gastroscopy. However, varicose veins can recur after treatment. The doctor will therefore carry out regular checks.
