Esophageal varices

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 15 Jan 2026

Last updated: 26 Mar 2025

Esophageal varices are a direct consequence of portal hypertension as a progressive complication of cirrhosis.

The development of bleeding carries significant morbidity and mortality.

Nonselective beta-blockers and/or endoscopic ligation can prevent the development of variceal bleeding.

Acute hemorrhage can be managed with resuscitation, a vasoactive therapy, and endoscopic ligation. Additional management may include transjugular intrahepatic shunt therapy and prophylactic antibiotics.

Diagnosis and surveillance are important aspects of management.

Определение

Esophageal 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.[1][2] Once cirrhosis has developed, increasing hepatic vein pressure gradient and deteriorating liver function may result in the formation of esophageal varices.

Rupture of esophageal varices can cause life-threatening bleeding. The most important predictor of variceal hemorrhage is the size of varices, with the highest risk of first hemorrhage occurring in patients with large varices (15% per year).[3][4] Other important predictors of hemorrhage are decompensated cirrhosis (Child-Pugh B/C) and the endoscopic finding of red wale marks.[3][5]

Анамнез и осмотр

Ключевые диагностические факторы

cirrhosis
severe liver disease
alcohol misuse
hepatitis B or C infection
ascites
spider angioma
caput medusa
jaundice
encephalopathy
hematemesis
melena
hematochezia
HIV coinfection

Полная информация

Другие диагностические факторы

splenomegaly

Полная информация

Факторы риска

portal hypertension
size of varices
red wale marks
decompensated cirrhosis
ascites

Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

hepatic venous pressure gradient (HPVG)
complete blood count
coagulation profile (INR/prothrombin time)
serum LFTs
BUN and creatinine
blood typing/cross-matching
hepatitis B surface antigen (HBsAg)
anti-hepatitis C virus IgG (anti-HCV IgG)
esophago-gastro-duodenoscopy (EGD)
liver stiffness measurement (LSM)

Полная информация

Неотложные исследования

capsule endoscopy

Полная информация

Алгоритм лечения

Острый

decompensated cirrhosis with acute variceal hemorrhage (hepatic venous pressure gradient ≥10 mmHg)

decompensated cirrhosis with acute variceal hemorrhage and failed endoscopic/pharmacologic therapy

ПРОДОЛЖЕНИЕ

compensated cirrhosis with mild portal hypertension (hepatic venous pressure gradient >5 and <10 mmHg)

compensated cirrhosis with clinically significant portal hypertension (hepatic venous pressure gradient ≥10 mmHg): without gastroesophageal varices

compensated cirrhosis with clinically significant portal hypertension (hepatic venous pressure gradient ≥10 mmHg): with gastroesophageal varices (no bleeding)

previous variceal bleed

Составители

Эксперты-консультанты

Savio John, MD, AGAF, FACG

Chief (Division of Gastroenterology), Director (Hepatology), Associate Professor

Department of Medicine

State University of New York Upstate Medical University

Syracuse

Раскрытие информации

SJ serves as editor of the hepatology section for Stat Pearls.

Kelita Singh, MD

Associate Professor of Medicine

Department of Gastroenterology

State University of New York Upstate Medical University

Syracuse

Раскрытие информации

KS declares that she has no competing interests.

Выражение благодарностей

Dr Savio John and Dr Keilita Singh would like to gratefully acknowledge Dr Grace E. Dolman, Dr Gennaro D'Amico, Dr Giuseppe Malizia, Dr Vikram Boolchand, and Dr Thomas Boyer, previous contributors to this topic.

Раскрытие информации

GED, GDA, GM, VB, and TB declare that they have no competing interests.

Рецензенты

Shreyas Saligram, MD, MRCP, FACG, FASGE

Assistant Professor

Department of Gastroenterology

University of California

San Francisco

Раскрытие информации

SS declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Kaplan DE, Ripoll C, Thiele M, et al. AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis. Hepatology. 2024 May 1;79(5):1180-211.Полный текст Аннотация

de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII - renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-74.Полный текст Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Hiatal hernia
- Gastric varices
- Mallory-Weiss tear
Больше Differentials
Guidelines
- AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis
- American College of Gastroenterology–Canadian Association of Gastroenterology clinical practice guideline: management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period
Больше Guidelines
Calculators
Child Pugh classification for severity of liver disease
More Calculators
Patient information
Hepatitis B: should I have the vaccine?
Hepatitis C: what is it?
More Patient information
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Esophageal varices

Summary

Определение

Анамнез и осмотр

Ключевые диагностические факторы

Другие диагностические факторы

Факторы риска

Диагностические исследования

Исследования, которые показаны в первую очередь

Неотложные исследования

Алгоритм лечения

decompensated cirrhosis with acute variceal hemorrhage (hepatic venous pressure gradient ≥10 mmHg)

decompensated cirrhosis with acute variceal hemorrhage and failed endoscopic/pharmacologic therapy

compensated cirrhosis with mild portal hypertension (hepatic venous pressure gradient >5 and <10 mmHg)

compensated cirrhosis with clinically significant portal hypertension (hepatic venous pressure gradient ≥10 mmHg): without gastroesophageal varices

compensated cirrhosis with clinically significant portal hypertension (hepatic venous pressure gradient ≥10 mmHg): with gastroesophageal varices (no bleeding)

previous variceal bleed

Составители

Эксперты-консультанты

Savio John, MD, AGAF, FACG

Раскрытие информации

Kelita Singh, MD

Раскрытие информации

Выражение благодарностей

Раскрытие информации

Рецензенты

Shreyas Saligram, MD, MRCP, FACG, FASGE

Раскрытие информации

Peer reviewer acknowledgements

Disclosures

Список литературы

Основные статьи

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Calculators

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice