Esophageal varices are abnormal, enlarged veins in the lower part of the esophagus. Esophageal varices occur most often in people suffering from serious liver diseases.

Esophageal varices form when normal blood flow to the liver is obstructed by scar tissue in the liver or a blood clot. As a result, blood flows into smaller blood vessels that are not designed to carry large volumes of blood. The vessels may leak blood or rupture causing life-threatening bleeding.



In general, esophageal varices don’t cause any symptoms unless they bleed. Symptoms of bleeding esophageal varices include:


  • Vomiting blood
  • Black, tarry or bloody stools
  • Shock (in severe cases)


The following symptoms of liver disease may also indicate esophageal varices:


  • Yellowing of the skin and whites of the eyes (jaundice)
  • A cluster of tiny blood vessels on the skin (spider nevi)
  • Reddening of the skin on the palms (palmar erythema)
  • A hand deformity (Dupuytren’s contracture)
  • Swollen spleen
  • Fluid buildup in the abdomen (ascites)
  • Shrunken testicles



Esophageal varices usually form when blood flow to the liver is obstructed, most often by scar tissue in the liver caused by liver disease. The blood flow then begins to back up increasing the pressure in the portal vein.

Portal hypertension forces the blood to search other pathways through smaller veins (as the ones in the lower part of the esophagus).  Too much blood in the small veins may cause the veins to rupture and bleed.


Causes of esophageal varices include:


  • Severe liver scarring (cirrhosis)
  • Blood clot (thrombosis)
  • Parasitic infection (Schistosomiasis – parasite that damages the liver, lungs, intestine and bladder)
  • Budd-Chiari syndrome (rare condition that causes blood clots)


Risk factors

Factors that increase the risk of bleeding of the esophageal varices:


  • High portal vein pressure (portal hypertension)
  • Large varices
  • Red marks on the varices (high risk of bleeding)
  • Severe cirrhosis or liver failure
  • Continuous alcohol use



The most serious complication of esophageal varices is bleeding. The risk of bleeding is greatly increased after the initial bleeding episode. Large blood loss may cause one to go into shock, which can result in death.



There is currently no treatment to prevent the development of esophageal varices in people with cirrhosis. Medications may be successful in preventing bleeding but they do not prevent eshophageal varices from forming.


The following tips may help avoid liver disease complications or help keep the liver healthy:


  • Avoiding alcohol use
  • Healthy diet
  • Maintaining a healthy weight
  • Careful use of chemicals
  • Reducing the risk of hepatitis