Esophageal varices

Last reviewed: 20 Apr 2022
Last updated: 15 Jan 2020

Summary

Definition

History and exam

Key diagnostic factors

  • cirrhosis
  • more severe liver disease
  • alcohol misuse
  • hepatitis B or C infection
  • ascites
  • spider angioma
  • caput medusa
  • jaundice
  • encephalopathy
  • hematemesis
  • melena
  • hematochezia
  • HIV coinfection
More key diagnostic factors

Other diagnostic factors

  • splenomegaly
Other diagnostic factors

Risk factors

  • portal hypertension
  • large varices
  • red wale marks
  • Child-Pugh class
  • ascites
More risk factors

Diagnostic investigations

1st investigations to order

  • 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)
More 1st investigations to order

Emerging tests

  • capsule endoscopy

Treatment algorithm

ACUTE

decompensated cirrhosis with acute variceal hemorrhage (hepatic venous pressure gradient >12 mmHg)

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

ONGOING

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

Contributors

Authors

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

Clinical Research Fellow

Barts Liver Centre

Barts and the London School of Medicine and Dentistry

London

UK

Disclosures

GED declares that she has no competing interests.

Acknowledgements

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.

Disclosures

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

Peer reviewers

Shreyas Saligram, MD, MRCP, FACG, FASGE

Assistant Professor

Department of Gastroenterology

University of California

San Francisco

CA

Disclosures

SS declares that he has no competing interests.

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