WellSpan Home

Cirrhosis Complications: Variceal Bleeding

Topic Overview

In people who have cirrhosis, high blood pressure in the veins that carry blood from the intestines to the liver (portal hypertension) causes many problems. One serious complication of portal hypertension is variceal bleeding.

When blood pressure increases in the portal vein system, veins in the esophagus, stomach, and rectum enlarge to accommodate blocked blood flow through the liver. The presence of enlarged veins (varices) usually causes no symptoms. (They may be found during an endoscopy exam of the esophagus.) About 50 to 60 out of 100 people who have cirrhosis develop varices in the esophagus.footnote 1

As the blood pressure in the portal vein system continues to increase, the walls of these expanded veins become thinner, causing the veins to rupture and bleed. This is called variceal bleeding.

  • The more severe the liver damage and the larger the varices, the greater your risk is for variceal bleeding.
  • Of the people who develop varices, about 30 out of 100 have an episode of bleeding within 2 years of the diagnosis of varices.footnote 2

Variceal bleeding can be a life-threatening emergency. After varices have bled once, there is a high risk of bleeding again. The chance of bleeding again is highest right after the first bleed stops and gradually goes down over the next 6 weeks. If varices are not treated, bleeding can lead to death.

Treatment for variceal bleeding can be challenging and may include medicines as well as endoscopic therapy (endoscopic banding or sclerotherapy). For more information, see:

The American College of Gastroenterology recommends endoscopic screening for varices for anyone who has been diagnosed with cirrhosis. If your first test does not find any varices, you can be tested again in 2 to 3 years.footnote 2 You may need more frequent testing if you have large varices or have already had an episode of variceal bleeding, even if you are treated for your varices with beta-blockers or variceal banding. Recurrent bleeding is common.

Related Information

References

Citations

  1. Shah VH, Kamath PS (2010). Portal hypertension and gastrointestinal bleeding. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 2, pp. 1489-1516. Philadelphia: Saunders.
  2. Garcia-Tsao G, et al. (2007). Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. American Journal of Gastroenterology, 102(9): 2086-2102.

Credits

ByHealthwise Staff
Primary Medical ReviewerAdam Husney, MD - Family Medicine
Specialist Medical ReviewerW. Thomas London, MD - Internal Medicine, Hepatology

Current as ofMarch 28, 2018


Are you sure you would like to cancel?

All information will be lost.

Yes No ×

About the provider search

This search will provide you with WellSpan Medical Group and Northern Lancaster County (Ephrata) Medical Group primary care physicians and specialists. If we don’t have a WellSpan Medical Group physician to meet your criteria, the search will expand to include community physicians who partner with WellSpan Medical Group physicians through the WellSpan Provider Network or provide care to patients on the Medical Staffs of WellSpan’s Hospitals.

×

Schedule Your Next Appointment Online with MyWellSpan

Use your MyWellSpan patient portal any time to view available appointments, and pick the date and time that best suits your schedule.

Go to MyWellSpan

New to this practice?

If you don't have a WellSpan primary care provider and would like to schedule a new patient appointment with a provider who is accepting patients, just log into your MyWellSpan account, and go to the Appointment Center section. As you progress through the scheduling process, you will be able to see the offices that are accepting new patients in relation to your zip code. If you are not enrolled in MyWellSpan, go to https://my.wellspan.org, call 1-866-638-1842 or speak with a member of the staff at a participating facility to sign up. New patient scheduling not available at all practices/programs.

Already a patient at this practice?

If you already have a relationship with a WellSpan practice, simply log into your account, and go to the Appointment Center section. As you progress through the scheduling process, you will be able to schedule an appointment with any provider or practice that already counts you as a patient. Online scheduling varies by practice/program.

×