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Causes
By Mayo Clinic staff
Normally, blood from your intestine, spleen and pancreas enters your liver through a large blood vessel called the portal vein. But if scar tissue blocks circulation through your liver, the blood backs up, leading to increased pressure within the portal vein (portal hypertension). This forces blood into smaller veins in your esophagus, stomach and occasionally your rectum. The excess blood causes these fragile, thin-walled veins to balloon outward and sometimes to rupture and bleed. Once varices develop, they continue to grow larger.
Cirrhosis: A leading cause of esophageal varices
Esophageal varices are usually a complication of cirrhosis. This serious liver disorder, which is irreversible scarring of liver tissue, often results from alcoholic liver disease or hepatitis B or C infection. Another liver disorder, primary biliary cirrhosis, which destroys the small ducts that carry bile, can also cause scarring of liver tissue and lead to esophageal varices.
Sometimes chronic conditions other than cirrhosis lead to enlarged veins in the esophagus. These conditions include:
- Severe congestive heart failure. This occurs when your heart can't pump enough blood to meet your body's needs. In congestive heart failure, blood backs up into the vein between your liver and the right side of your heart, increasing blood pressure in the portal vein.
- Blood clot (thrombosis). A blood clot in the portal vein or in the splenic vein, which feeds into the portal vein, can cause esophageal varices.
- Sarcoidosis. This inflammatory disease starts in your lungs, but can affect almost any organ in your body, including your liver. It rarely causes cirrhosis.
- Schistosomiasis. This parasitic infection affects millions of people in the developing world, especially parts of Africa, South America, the Caribbean, the Middle East and Southeast Asia. It can damage the liver as well as the lungs, intestine and bladder.
- Budd-Chiari syndrome. In this rare condition, blood clots obstruct the veins that carry blood out of your liver.
- Dite P, et al. World Gastroenterology Organisation Practice Guidelines: Esophageal Varices. World Gastroenterology Organisation. http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/18_treatment_e_varices_en.pdf. Accessed Aug. 21, 2008.
- Sanyal, AJ. General principles of the management of variceal hemorrhage. http://www.uptodate.com/home/index.html. Accessed Aug. 21, 2008.
- Runyon, BA. Patient information: Screening for esophageal varices. http://www.uptodate.com/home/index.html. Accessed Aug. 21, 2008.
- Goff JS. Endoscopic variceal ligation. http://www.uptodate.com/home/index.html. Accessed Aug. 21, 2008.
- Portal hypertension. Merck Manuals Online Medical Library. http://www.merck.com/mmhe/print/sec10/ch135/ch135d.html. Accessed Aug. 21, 2008.
- Sanyal, AJ. Prediction of variceal hemorrhage. http://www.uptodate.com/home/index.html. Accessed Aug. 21, 2008.
- Sanyal, AJ. Treatment of active variceal hemorrhage. http://www.uptodate.com/home/index.html. Accessed Aug. 21, 2008.
- Sanyal, AJ. Primary prophylaxis against variceal hemorrhage in patients with cirrhosis. http://www.uptodate.com/home/index.html. Accessed Aug. 21, 2008.
- Sanyal, AJ. Prevention of recurrent variceal hemorrhage in patients with cirrhosis. http://www.uptodate.com/home/index.html. Accessed Aug. 20, 2008.
- Picco MF (expert opinion). Mayo Clinic, Jacksonville, Fla. Aug. 24, 2008.
