Varices from hepatitis C: A Complication of Cirrhosis

Esophageal varices are a complication of late stage hepatitis C. The liver becomes scarred, and the pressure from obstructed blood flow causes veins to expand. When blood pressure is increased within the portal venous system of veins, it is called portal hypertension. The veins in this system come from the pancreas, stomach, intestines, and spleen. They come together in the portal vein, branch into smaller vessels and travel through the liver. The elevated pressure causes varices which are abnormal enlarged veins. This happens most frequently in the esophagus, the tube between the mouth and the stomach. Varices may appear in the stomach as well, but not as frequently as esophageal varices. Varices in the stomach are called gastric varices.

What can someone with varices from cirrhosis expect?

Varices may become a serious, life-threatening problem. When left untreated esophageal varices will bleed in close to 30% to 40% of patients, many of whom will die from this complication. It is truly a medical emergency. Unfortunately, varices do not cause symptoms until they bleed. Bleeding causes vomiting of blood, dark-colored (black) stools, decreased urination, dizziness from anemia, and shock in severe cases.

Patients with cirrhosis should be monitored as varices can be treated lessening the chances of a fatal bleed. An upper endoscopy is the most used procedure to detect the enlarged veins. A person is sedated and a flexible tube with a camera is passed through the mouth into the esophagus. If a patient is found to have varices they need to be monitored yearly. If they are clear, it is recommended to repeat the procedure at 3 year intervals. A less frequently used procedure is called a capsule endoscopy. The patient swallows a tiny camera, lays on his/her right side and pictures are taken as the patient sips water at 30 second intervals. These pictures are reviewed by the doctor to see if enlarged veins are present. At that point the physician assesses the risk of a bleed and takes the appropriate steps to lessen the chance of a rupture.

How can varices be treated?

There are a number of treatments to prevent or reduce the occurrence of leaking or rupturing varices. Some patients are candidates for beta-blockers. These drugs lower the pressure in the blood vessels lessening the risk of bleeding. However, if the patient has ascites, beta-blockers may be contraindicated as they will make the ascites harder to handle. Avoidance of anything that makes the liver disease worse, such as drinking alcohol, is also recommended.

Another procedure that is also used is called variceal band ligation. Tiny rubber bands are placed around the vessels during an endoscopy. This is followed by repeat endoscopies to determine if more bands are needed.

If you are a hepatitis C patient who has been diagnosed with stage 4 disease (cirrhosis), please ask your doctor about monitoring for varices. Untreated varices can kill.^1,2