Oesophageal varices

Last reviewed: 24 Apr 2022
Last updated: 22 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors for variceal bleeding
  • haematemesis
  • melaena
  • haematochezia
  • cirrhosis
  • severe liver disease
  • alcohol misuse
  • intravenous drug use
  • hepatitis B or hepatitis C infection
  • ascites
  • spider angioma
  • caput medusa
  • jaundice
  • encephalopathy
  • HIV co-infection
Full details

Other diagnostic factors

  • splenomegaly
Full details

Risk factors

  • portal hypertension
  • large varices
  • red wale marks
  • decompensated cirrhosis
  • ascites
Full details

Diagnostic investigations

1st investigations to order

  • gastroscopy
  • full blood count
  • electrolytes
  • serum LFTs
  • serum urea and creatinine
  • coagulation profile (INR/prothrombin time)
  • blood typing/cross-matching
  • hepatitis B surface antigen (HBsAg)
  • anti-hepatitis C virus IgG (anti-HCV IgG)
Full details

Investigations to consider

  • capsule endoscopy
  • liver ultrasound
Full details

Treatment algorithm

ACUTE

acute variceal bleeding

ONGOING

no acute variceal bleeding: medium to large varices

no acute variceal bleeding: small varices

previous variceal bleed

Contributors

Expert advisers

Joe Geraghty, BSC (Hons), MB BS (Dist), MRCP, PhD

Consultant Gastroenterologist

Department of Gastroenterology

Manchester Royal Infirmary

Central Manchester University Hospitals NHS Foundation Trust

Manchester

UK

Disclosures

JG declares that he has no competing interests.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:

Grace E. Dolman, PhD, MA (Cantab), MRCP

Clinical Research Fellow

Barts Liver Centre

Barts and the London School of Medicine and Dentistry

London

UK

Peer reviewers

Andrew Austin, PhD, FRCP

Consultant Hepatologist

Lead Clinician in Gastroenterology

Royal Derby Hospital

Derby

UK

Disclosures

AA declares that he has no competing interests.

Editors

Helena Delgado-Cohen,

Section Editor, BMJ Best Practice

Disclosures

HDC declares that she has no competing interests.

Tannaz Aliabadi-Oglesby,

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Annabel Sidwell,

Comorbidities Editor, BMJ Best Practice

Disclosures

AS declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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