From the Guidelines
Esophageal varices often present with no symptoms until they rupture and bleed, and the most dramatic sign is hematemesis (vomiting of blood), which may be bright red or have a coffee-ground appearance, as noted in the most recent study 1. The signs and symptoms of esophageal varices can be subtle and may not always be present until a severe complication such as bleeding occurs.
- Hematemesis (vomiting of blood) is a common presentation, which may be bright red or have a coffee-ground appearance due to partial digestion of the blood in the stomach.
- Melena (black, tarry stools) is also common due to blood passing through the digestive tract.
- Patients may experience symptoms of blood loss including:
- Lightheadedness
- Dizziness
- Fatigue
- Syncope
- In severe cases, hemorrhagic shock can develop with:
- Tachycardia
- Hypotension
- Altered mental status
- Other potential signs include:
- Abdominal pain
- Chest pain
- Dysphagia (difficulty swallowing) Risk factors that should raise suspicion include:
- Cirrhosis
- Chronic alcoholism
- Hepatitis
- Portal hypertension Early recognition is critical as variceal bleeding has a high mortality rate, and patients with these symptoms require immediate medical attention for endoscopic evaluation, hemodynamic stabilization, and potential interventions such as band ligation, sclerotherapy, or placement of a transjugular intrahepatic portosystemic shunt (TIPS) in severe cases, as recommended by the most recent guidelines 1.
From the Research
Signs and Symptoms of Esophageal Varices
The signs and symptoms of esophageal varices are not explicitly stated in the provided studies, but we can infer some information related to the condition:
- Esophageal varices are a complication of chronic liver disease and portal hypertension, which can lead to bleeding 2, 3, 4, 5.
- Bleeding from esophageal varices can be a catastrophic event with high morbidity and mortality 2, 3, 4, 5.
- The studies discuss the treatment and management of bleeding esophageal varices, but not the specific signs and symptoms that precede bleeding.
Related Information
Some studies provide information on the diagnosis and treatment of esophageal varices:
- The Japan Society for Portal Hypertension has a grading system for esophagogastric varices, which classifies varices into different categories 2.
- Endoscopic variceal ligation (EVL) is a common treatment for bleeding esophageal varices, with a high success rate in controlling acute bleeding 3, 4.
- Other treatment options include pharmacologic therapy, surgery, interventional radiology, and endoscopic injection sclerotherapy 2, 4, 5.
Specific Cases
One study reports an unusual case of variceal hemorrhage in a patient with a history of Heller myotomy, who was seen to have no varices on endoscopic evaluation only a month earlier 6. This case highlights the potential for rapid development of esophageal varices in certain patients.