A direct consequence of portal hypertension as a progressive complication of cirrhosis.
The development of bleeding carries significant morbidity and mortality.
Non-selective beta-blockers and/or endoscopic ligation can prevent the development of variceal bleeding.
Acute haemorrhage can be managed with resuscitation, a vasoactive drug or a somatostatin analogue, and endoscopic ligation. Additional management may include trans-jugular intrahepatic shunt therapy and prophylactic antibiotics.
Diagnosis and surveillance by endoscopy is an important aspect of management.
Oesophageal varices are dilated collateral blood vessels that develop as a complication of portal hypertension, usually in the setting of cirrhosis. They can be seen on endoscopy. In the US and Europe the major cause of cirrhosis is alcoholic liver disease. Worldwide, hepatitis B virus infection and hepatitis C virus infection are the major causes of cirrhosis. Once cirrhosis has developed, increasing hepatic vein pressure gradient and deteriorating liver function may result in the formation of oesophageal varices.
Rupture of oesophageal varices can cause life-threatening bleeding. The most important predictor of variceal haemorrhage is the size of varices, with the highest risk of first haemorrhage occurring in patients with large varices (15% per year). Other important predictors of haemorrhage are decompensated cirrhosis (Child-Pugh B/C) and the endoscopic finding of red wale marks.
History and exam
- hepatic venous pressure gradient (HPVG)
- full blood count
- coagulation profile (INR/prothrombin time)
- serum LFTs
- urea and creatinine
- blood typing/cross-matching
- hepatitis B surface antigen (HBsAg)
- anti-hepatitis C virus IgG (anti-HCV IgG)
- oesophago-gastro-duodenoscopy (OGD)
Clinical Research Fellow
Barts Liver Centre
Barts and the London School of Medicine and Dentistry
GED declares that she has no competing interests.
Dr Grace E. Dolman would like to gratefully acknowledge Dr Gennaro D'Amico, Dr Giuseppe Malizia, Dr Vikram Boolchand, and Dr Thomas Boyer, previous contributors to this topic.
Department of Gastroenterology
University of California
SS declares that he has no competing interests.
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