Varices and variceal bleeding

What causes varices?

A liver with cirrhosis has a lot of scars. These scars make it hard for blood to pass through the liver normally. But the blood still tries to push through. This increases the pressure inside the liver’s blood vessels. This causes a problem called portal hypertension. Find out more about portal hypertension here.

High blood pressure in the liver has a knock-on effect. It increases the pressure in other blood vessels that link to the liver.

In particular, it affects blood vessels in the food pipe (oesophagus) and stomach. If enough blood cannot get through big blood vessels, it gets redirected to smaller veins. Like traffic having to use country lanes because a motorway is shut.

The small veins are not supposed to carry this much blood. So they swell up, which weakens them. Putting them at risk of leaking or bursting.

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What are the symptoms of varices and variceal bleeding?

Varices do not usually cause any symptoms that you would notice. Some people feel some discomfort when they swallow.

But when varices bleed (called a variceal bleed) there are often clear signs, especially if there is a lot of bleeding. Losing a lot of blood quickly causes a condition called shock.

A variceal bleed is an emergency. If you have symptoms of a variceal bleed or of shock, go to a hospital emergency department (A&E) or call an ambulance straight away. Tell the 999 call handler that you may have a variceal bleed.

Symptoms of a variceal bleed:

• Vomiting blood
• Black, tarry or bloody poo

Symptoms of shock:

• fast, shallow breathing
• Unusually fast heart rate
• cold, clammy, pale skin
• weak pulse
• dizziness, fainting or weakness

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How are varices diagnosed?

If you have symptoms of varices, you should have a procedure called an endoscopy.

An endoscope is a long thin tube with a light and camera on the end. It’s bendy so it can be put down your food pipe to let your doctor see what is happening.

During an endoscopy, you will have a local anaesthetic or sometimes a sedative. If it is an emergency because you are bleeding a lot, you might have a general anaesthetic. In this case you will have a tube placed in your throat to stop blood doing into your lungs or making it difficult to breathe.

Find out more about endoscopies.

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Varices screening

Everyone with cirrhosis should have checks to see if they are at risk of varices. You might hear this called screening or surveillance.

This check might be an endoscopy. But some hospitals first do a blood test to check platelet levels and a FibroScan to check how much scarring there is in your liver.

If the results of these tests show that you are at low risk of varices you may not need to have an endoscopy. You should have the blood test and scan again after a year.

If you have an endoscopy and no varices are found, you should have another check in 2 to 3 years.

If small varices are found, you should have another check in 1 to 2 years. Or you might be given a medicine to lower the pressure in the veins.

If the varices are larger, you should be given medicine to prevent a bleed. You might also have some treatment during the endoscopy. This is called banding. You can find out more about banding further down this page. If you have banding, you will need a repeat endoscopy 1 to 2 months later to make sure the treatment has worked and to apply more bands if required to try to better control the varices. It is normal for people to need a few endoscopies to get control of these varices.

If you have been diagnosed with cirrhosis and you have not been offered screening for varices speak to your medical team.

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Preventing variceal bleeds

If you have varices, the main goal of treatment is stopping them bursting and causing a variceal bleed. You might hear this called prevention or prophylaxis.

Blood-pressure medicine

You may be prescribed a medicine called a ‘beta-blocker’ or another similar medicine. These are very common treatments for high blood pressure. They reduce the pressure and swelling in the varices by reducing the blood pressure in the veins around your liver.

Clotting and banding

These methods are used to prevent bleeding and to treat it. You can find out more about them in the next section.

More about banding and clotting treatments

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How is variceal bleeding treated?

There are a number of treatments for variceal bleeding. Your doctor should explain which treatment they are recommending and why. Ask them to explain anything that is not clear.

In an emergency you might not be able to properly talk about the different treatment options. So it is a good idea to find out more about them in advance just in case. You could also talk about the treatment options with close family or friends, so they can talk to doctors for you if you are too poorly.

Future treatments for Varices

Research is looking into new ways to treat and manage varices.

The BOPPP trial

This is a large UK clinical trial. It is looking to see if a medicine to lower the pressure in the veins should be given to prevent problems like bleeding in people with cirrhosis who have not bled before.

Find out more about BOPPP

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Living with Varices

Knowing that you have varices, or you are at risk of them, can be very worrying. Variceal bleeding can be a life-threatening condition. But being well informed can help to keep you as well as possible.

Make sure you take any medicines prescribed by your doctor exactly as instructed. If you have cirrhosis, ask your medical team about checks for varices if you have not already had these.

Alcohol

Drinking alcohol increases the pressure in the varices and can cause bleeding. You should avoid drinking any alcohol. If this will be difficult for you, talk to your medical team and ask if there is any support available to help you.

Flying

There is a possible risk of bleeding from varices if you fly, even for short trips. This is because of the pressure changes during the flight. If you are planning on flying, please talk to your medical team first. You may need to wait until your treatment is working properly. You will need to tell your travel insurance provider that you have varices.

It might help to share this information with those closest to you to help them to understand your condition. And so they know what to do in an emergency.

Getting support

Lots of people live with varices. So you are not alone and there is support available for you.

The British Liver Trust has lots of ways to support you. Including an online forum, support groups, and our nurse led helpline.

Find out more about our support services

Living with a liver condition

Family friends and carers

Cirrhosis

Complications of decompensated cirrhosis

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Find out about other cirrhosis complications

Special thanks

We would like to thank all of the medical specialists, and people with personal experience of cirrhosis who helped us to plan, develop, and review this information.

Including members of our patient advisory group, Jennifer Voller, Michael Kennedy, Dr Victoria Kronsten, Senior Clinical Research Fellow in Hepatology, King’s College Hospital, Katharine Caddick, Consultant Nurse, North Bristol Trust. Maria-Emanuela Maxan, Senior Clinical Research Fellow in Hepatology, King’s College Hospital and Dr Vishal Patel, Consultant Hepatologist, Kings College hospital.

Published: March 2025