Esophageal Variceal Bleeding

By | June 10, 2022

Bleeding from esophageal varices is bleeding from varicose veins within the esophagus. It is classified as a medical emergency and is life-threatening.

What is esophageal variceal bleeding?

Varicose veins (varicose veins) in the esophagus (esophagus) are referred to as esophageal varices. They are mostly caused by high pressure in the portal vein ( portal hypertension ). Esophageal varices cause the veins within the esophagus to expand. They are often a complication of advanced liver cirrhosis.

But other diseases can also be responsible for the occurrence of esophageal varices. In the context of liver cirrhosis, esophageal varices appear in around 50 percent of all patients. If there is bleeding from an esophageal varice, about 30 percent of all affected people die despite medical treatment. The risk of bleeding in the esophagus recurring is about 70 percent. For what is the definition of rna, please visit


Esophageal variceal bleeding is caused by a tear in the varices in the esophagus. Varicose veins in the esophagus form when blood can no longer drain properly from the liver, as in the case of advanced cirrhosis of the liver. The blood seeks an alternative circuit towards the heart. This creates increased pressure in the hepatic veins, which leads to blood congestion in the liver. Doctors then speak of portal hypertension.

So that the blood can still be transported to the heart, the blood searches for other routes via existing collateral circulation. The heavy strain that comes about as a result ultimately results in the formation of varicose veins. Esophageal variceal bleeding occurs when the thin vessel wall is injured externally.

These can be caused, among other things, by solid foods. Another trigger is increased vascular pressure during defecation, which causes abdominal pressure. The varicose veins do not have muscles strong enough to regulate and stop the bleeding. This means that the large amount of blood cannot get past the liver.

This in turn causes the esophageal veins to stretch out. As the veins progress, they thin out more and more until they finally burst. There are several risk factors for esophageal variceal bleeding. These include the consumption of alcohol despite cirrhosis of the liver, the existence of extensive oesophageal varices and bleeding in the oesophagus.

Symptoms, Ailments & Signs

Esophageal varices show symptoms late. They are characterized by esophageal variceal bleeding, in which patients suddenly vomit blood. The blood appears in surges and in large quantities. It can also flow directly from the esophagus into the stomach, which in turn causes tarry stool.

As the blood comes into contact with the hydrochloric acid in the stomach, it becomes black in color due to chemical changes. Another sign of esophageal variceal bleeding is pale skin in the affected person, which is due to significant blood loss. This causes the blood pressure to drop.

Esophageal variceal bleeding is considered life-threatening and represents a medical emergency. There is a risk that the patient will die within a short time. Bleeding in the esophagus is the most common cause of death in liver cirrhosis. The more advanced the cirrhosis of the liver, the greater the risk of death from bleeding from the esophageal varices.

Diagnosis & course of disease

Endoscopy is usually used to diagnose esophageal variceal bleeding. For this purpose, the doctor inserts a thin tube equipped with a camera into the esophagus via the oral cavity. With the help of a connected monitor, the doctor is able to examine the esophageal mucosa and identify the esophageal varices.

It is also important to make a differential diagnosis in relation to other causes that can be considered for bleeding in the gastrointestinal tract. This can be inflammation of the gastric mucosa or stomach ulcers. It is not uncommon for esophageal variceal bleeding to take a negative course despite hemostasis.

Around 30 percent of all patients die from it. In most cases, the reason for this is shock due to the massive bleeding. Even if the first bleeding is survived, about a third of those affected die from recurrent bleeding.


Esophageal variceal bleeding is an extremely life-threatening emergency. Even with treatment, the death rate is high. Up to 30 percent of all patients die, even under therapy. Without treatment, of course, mortality is much higher, approaching 100 percent.

It is usually a very massive bleeding when the bulging blood-filled varicose veins in the esophagus rupture. There is a life-threatening blood loss that can only be stopped by quick clamping or sclerotherapy of the affected varices. Even if the bleeding is stopped, another 30 percent of those affected die from recurrent bleeding.

The causes of the often fatal course of esophageal variceal bleeding are, in addition to the high blood loss and the resulting fluid loss, suffocation attacks, pneumonia due to blood aspiration when inhaling or the development of sepsis with multi-organ failure. Since esophageal variceal bleeding is usually caused by severe cirrhosis of the liver, other serious and sometimes fatal complications often occur.

In the acute stage, bleeding from the esophageal varices can only be treated symptomatically. With the help of this therapy, only its immediate effects can be prevented. A real cure is only possible with the help of a curative treatment of the liver failure. If the cause is not eliminated, recurrent bleeding will occur again and again. Sometimes the only way to save a patient’s life is with the help of a liver transplant.

When should you go to the doctor?

Vomiting blood or sudden acute health changes are considered to be of high concern. Since esophageal variceal bleeding is an emergency, medical attention must be initiated immediately. If the affected person notices any abnormalities in the area of ​​​​the esophagus, there is a sudden decrease in well-being or a feeling of illness, a doctor should be consulted. There is a need for action if you have an inner weakness, a pale complexion or abnormalities when going to the toilet. Blood in the urine or stool are alarm signals from the body.

If there are impairments in locomotion, if the person concerned experiences a loss of physical resilience or if he complains of muscle weakness, a doctor must be consulted as soon as possible. If left untreated, the disease can lead to premature death. There is internal bleeding leading to a loss of internal strength. If the person concerned can no longer carry out his usual physical activities without help or discomfort, he needs help. In acute cases, an emergency service must be alerted and first aid measures must be applied at the same time. A change in the state of health within a few minutes is characteristic. a low blood pressure,

Treatment & Therapy

Immediate medical care is required in the event of esophageal variceal bleeding, as there is a high risk of death. One of the most important therapeutic measures is the stabilization of the circulatory system, because the patient loses a lot of blood and fluid in a short time. To counteract this condition, the patient is given fluids intravenously.

If necessary, a blood transfusion can also be done. An attempt is also made to stop the bleeding. The doctor usually performs an endoscopic ligation. This means that he ties off the esophageal varices using plastic clips. Hemostasis with medication is also possible. For this purpose, the patient is given drugs such as somatostatin or terlipressin.

They have a lowering effect on blood pressure within the portal vein system. If there is heavy bleeding, there is the option of inserting a balloon tamponade into the lower esophagus. The doctor inflates the balloon in the esophagus, which squeezes the blood vessels. However, because the risk of complications is considered high, an endoscopy or the administration of medication are primarily used.

Another part of the therapy is the administration of antibiotics. In this way, a possible infection with bacteria is counteracted. Therefore, the patient is given ciprofloxacin for a few days. If esophageal variceal bleeding occurs in connection with liver cirrhosis, it is important to prevent liver coma.


Esophageal variceal bleeding cannot be prevented. For this reason, it is important to treat underlying diseases in good time.

You can do that yourself

If there is a taste of blood in the back of the throat, the affected person should consult a doctor immediately. Esophageal variceal bleeding is a medical emergency. Self-help measures are not enough to be able to provide adequate health care on one’s own responsibility.

In the future, sick people should pay more attention to the intake of their food. Food containing pointed or sharp elements should under no circumstances be eaten. They include, for example, bones in fish, crispbread or rusks. These could cause damage to the esophagus. In addition, it is important to ensure that the purchase process is optimized. Ingested food is sufficient to be ground in the mouth by the teeth before being pushed down the throat. It should be broken up into small pieces beforehand.

In the event of a drop in blood pressure, weakness or a general feeling of being unwell, a doctor should be consulted immediately or an emergency service should be alerted. There is a potential danger to life, which makes it necessary to get medical care as quickly as possible.

In addition, physical activities that put a heavy strain on the organism should be avoided. The design of leisure time and sporting activities should be optimized by those affected on the basis of the possibilities of the organism.

Esophageal Variceal Bleeding