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Risk factors
By Mayo Clinic staffAlthough many people with advanced liver disease develop esophageal varices, less than half experience bleeding. Varices are more likely to bleed if you have:
- High portal vein pressure. The risk of bleeding increases with the amount of pressure in the portal vein.
- Large varices. The larger the varices, the more likely they are to bleed.
- Red marks on the varices. When viewed through an endoscope — a lighted, fiber-optic instrument — some varices show long, red streaks or red spots. These marks indicate a high risk of bleeding.
- Severe cirrhosis or liver failure. Most often, the more severe your liver disease, the more likely varices are to bleed.
- Fluid buildup. Liver disease can cause large amounts of fluid to accumulate in your abdominal cavity (ascites). Several factors play a role in fluid buildup, including portal hypertension and changes in the hormones and chemicals that regulate fluids in your body. Having this excess fluid increases your risk of variceal bleeding.
- Continued alcohol use. If your liver disease is alcohol related, your risk of variceal bleeding is far greater if you continue to drink than if you stop.
- Acid reflux. Stomach or bile acids that back up (reflux) into the esophagus erode the esophageal lining, which can trigger bleeding.
References
- 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.
