Normally, blood from your intestine, spleen and pancreas enters your liver through a large blood vessel called the portal vein. But if scar tissue blocks circulation through your liver, the blood backs up, leading to increased pressure within the portal vein (portal hypertension).
This is an increase in the blood pressure in the portal vein, which carries the blood from the bowel and spleen to the liver. The pressure in the portal vein may rise because there is a blockage, such as a blood clot, or because the resistance in the liver is increased because of scarring, or cirrhosis. As a result, the pressure in the portal vein rises – this is known as portal hypertension. As the blood tries to find another way back to the heart, new blood vessels open up. Once varices develop, they continue to grow larger.
Among these vessels are those that run along the wall under the lining of the upper part of the stomach and the lower end of the esophagus (gullet). These veins protrude into the gullet and the stomach and can bleed. This bleeding may be a gentle ooze in which case anemia is the commonest symptom. Sometimes there can be a major bleed and the person has a hemorrhage and either vomits blood or passes blood through the bowels. This blood may appear to be black, since it is often changed as it passes through the body.
Varices do not cause symptoms until they leak or rupture, leading to extensive bleeding. About one-third of people with esophageal varices will develop bleeding.
The signs and symptoms of esophageal bleeding range from mild to severe and include:
Black, tarry or bloody stools
Decreased urination from unusually low blood pressure
Shock, in severe cases
If you've been diagnosed with esophageal varices and experience bloody vomit or stools, call 911 or your local emergency services right away. These may indicate that esophageal varices have ruptured — a life-threatening condition that requires immediate medical care.
How is portal hypertension diagnosed?
Endoscopic examination, X-ray studies, and lab tests can confirm that you have variceal bleeding. Further treatment is necessary to reduce the risk of recurrent bleeding.
What are the treatment options for portal hypertension?
The effects of portal hypertension can be managed through diet, medications, endoscopic therapy, surgery, or radiology. Once the bleeding episode has been stabilized, treatment options are prescribed based on the severity of the symptoms and on how well your liver is functioning.