Varicose veins in the esophagus: Causes, symptoms, treatment

When the veins in the esophagus swell, they become weakened and complications easily arise, which can sometimes be very serious. This article discusses, among other things, the causes, symptoms, complications and treatment of these esophageal varices. The esophagus is a tube composed mainly of muscles. These muscles ensure that food and drink are transported to the stomach. In addition to muscles, the esophagus also consists of a layer of connective tissue, which in turn produces mucous membrane. Thin veins run through the muscles and connective tissue that supply the entire esophagus with blood. If these veins come under high (blood) pressure, they swell and form varicose veins.


The increased (blood) pressure is always caused by problems with the portal vein. The portal vein is a large vein that carries blood from other organs to the liver. If this portal vein experiences too much pressure (portal hypertension), the blood looks for another way to reach the heart. Very often the veins of the esophagus are used for this, although they are of course not designed for this. The result is that these esophageal veins swell and thus form varicose veins. If the portal vein experiences too much pressure, this is usually the result of an underlying condition or disease. Conditions or diseases that can cause portal hypertension include:

  • Liver cirrhosis (number 1 in Western countries)
  • Clotting abnormalities and problems (such as thrombosis)
  • Budd-Chiari Syndrome
  • Congenital abnormality of the liver
  • General infection in the abdomen (particularly in children)
  • General heart and blood vessel disorders

Sometimes it is not immediately possible to find a cause for increased portal vein pressure.


Varicose veins in the esophagus in themselves hardly or even have no symptoms. Only when the varicose veins start to bleed do you notice that something is wrong. Bleeding varicose veins in the esophagus can cause:

  • Vomiting clear blood
  • Black stools
  • Feeling generally weak and looking pale

If you experience these symptoms, it is strongly recommended that you seek medical attention.
All patients with esophageal varices also suffer from increased pressure in the portal vein. If you have symptoms of increased portal vein pressure and/or an underlying disease, this may indicate further investigation into esophageal varices.


The diagnosis of esophageal varices is always made by means of an endoscopy (a keyhole operation that allows one to view the inside of the esophagus through the mouth with a tube and camera). The doctor can use this camera to visually determine whether or not esophageal varices are present.


If the varicose veins are swollen for a long time, the walls become weak and there is a risk of bleeding. Major bleeding in particular can be fatal because you simply lose too much blood at once. There is also the risk that blood from the esophagus ends up in the lungs, or that an infection occurs.


If the varicose veins do not bleed

If the varicose veins do not bleed, it is especially important to properly treat the underlying conditions so that the portal hypertension is resolved. If the pressure in the portal vein drops, the swelling in the esophageal varices will also decrease.
Sometimes they are treated locally and preventively during endoscopy.

If the varicose veins do bleed

Various treatments can be used for varicose vein bleeding, including in combination:

  • Blood transfusion: to compensate for blood loss.
  • Different types of medication through an IV.
  • Treatment via the endoscope: The varicose vein can be treated locally via a tube.
  • Inflate a balloon in the esophagus to compress the varicose veins (this can only be used temporarily in emergency situations).
  • Installing a shunt so that the high pressure in the portal vein can drop. This is a major operation.
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