Digestive Problems and Bleeding Varices

Varices are dilated blood vessels in the esophagus or stomach caused by portal hypertension. They cause no symptoms unless they rupture and bleed, which can be life-threatening.

Someone with symptoms of bleeding varices should seek treatment immediately. Doctors can stop the bleeding and help prevent varices from coming back.

Symptoms of Bleeding Varices

Symptoms include:

• Vomiting of blood
• Black, tarry, or bloody stool
• Low blood pressure
• Rapid heart rate
• Lightheadedness
• Shock (in severe cases)

Bleeding from varices is a medical emergency. If the bleeding is not controlled quickly, a person may go into shock or die.

Even after the bleeding has been stopped, there can be serious complications, such as pneumonia, sepsis, liver failure, kidney failure, confusion, and coma.

Cause of Bleeding Varices

Portal hypertension is an increase in the pressure within the portal vein (the vein that carries blood from the digestive organs to the liver). It's often due to scarring of the liver, or cirrhosis.

This increased pressure in the portal vein causes blood to be pushed away from the liver to smaller blood vessels, which are not able to handle the increased amount of blood. This leads to the development of large, swollen veins (varices) within the esophagus, stomach, rectum, and umbilical area (around the belly button). The varices are fragile and can rupture easily, resulting in a large amount of blood loss.

Treatments for Bleeding Varices

In severe cases, a person may need to be placed temporarily on a breathing machine to prevent the lungs from filling with blood. Antibiotics are also given immediately to reduce the risk of sepsis, a life-threatening blood infection.

Aside from the urgent need to stop the bleeding, treatment is also aimed at preventing more bleeding. Procedures that help treat bleeding varices include:

• Banding. A gastroenterologist places small rubber bands directly over the varices. This will stop the bleeding and get rid of the varices.
• Sclerotherapy. A gastroenterologist directly injects the varices with a blood-clotting solution instead of banding them.
• Transjugular Intrahepatic Portosystemic Shunt (TIPS). A radiological procedure in which a stent (a tubular device) is placed in the middle of the liver. The stent connects the hepatic vein with the portal vein. This procedure is done by placing a catheter through a vein in the neck. It is done to relieve the high blood pressure that has built up in the portal vein and the liver.
• Distal Splenorenal Shunt (DSRS). A surgical procedure that connects the splenic vein to the left kidney vein in order to reduce pressure in the varices and control bleeding.
• Liver transplant. A liver transplant may be done in cases of end-stage liver disease.
• Devascularization. A surgical procedure that removes the bleeding varices. This procedure is done when a TIPS or a surgical shunt isn't possible or unsuccessful in controlling the bleeding.
• Esophageal transection. A surgical procedure in which the esophagus is cut through and then stapled back together after the varicies have been tied off. Sometimes there is bleeding at the staple line

Can Bleeding Varices Be Prevented?

Treating the underlying cause of bleeding varices can help prevent their return. Earlier treatment of liver disease may prevent them from developing.

Certain medications, including the class of heart drugs called "beta-blockers," may reduce elevated portal pressure and lower the likelihood of bleeding. Long- acting nitroglycerines are also used for this purpose.

Also, talk with your doctor about possible procedures that can be done and that have an effect on bleeding.

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