Skip to Content

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.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.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.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

By Healthwise Staff
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer W. Thomas London, MD - Hepatology
Current as of March 12, 2014

Current as of: March 12, 2014

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

© 1995-2014 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

Classes & Events

  • Oct
    31
    Friday
    1:30 PM - 3:30 PM
    An education and support group for women recently diagnosed with breast or gynecological cancer.
  • Nov
    3
    Monday
    4:00 PM - 5:00 PM
    This beginner routine is suitable for anyone regardless of age, health, flexibility or previous experience.
  • Nov
    3
    Monday
    4:00 PM - 5:00 PM
    This orientation is intended to be a general information session on several of our popular weight management programs.

Section Links

Health Library