Variceal bleeding as a complication of cirrhosis

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 examination or a barium X-ray 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.

Variceal bleeding can be a life-threatening emergency. Once varices have bled, 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 medications as well as endoscopic therapy (endoscopic banding or sclerotherapy).

The American College of Gastroenterology recommends endoscopic screening for varices for anyone who has cirrhosis. If the screening does not find any varices, you should be screened again in the next 1 to 2 years. You may need more frequent monitoring 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.

Citations

1. 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.