Esophageal Varices: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Esophageal Varices?
A gastroenterologist, a doctor who treats the digestive system, usually treats esophageal varices. A hepatologist, a doctor who treats liver disease, often helps too, because the cause is usually a liver problem. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What are esophageal varices?
The esophagus is the tube that connects your throat to your stomach. Varices are enlarged veins that may be found in the esophagus in people with cirrhosis of the liver. Cirrhosis is scarring of the liver. These veins may rupture and bleed.
Varices can also occur in the upper part of the stomach. These are called gastric varices.
Symptoms
People with chronic liver disease and esophageal varices may have no symptoms. If there is only a small amount of bleeding, the only symptom may be dark or black streaks in the stools.
If larger amounts of bleeding occur, symptoms may include:
- Black, tarry stools.
- Bloody stools.
- Lightheadedness.
- Paleness.
- Vomiting blood.
- Symptoms of chronic liver disease.
Causes and who gets it
Scarring (cirrhosis) of the liver is the most common cause of esophageal varices. This scarring cuts down on blood flowing through the liver. As a result, more blood flows through the veins of the esophagus.
The extra blood flow causes the veins in the esophagus to balloon outward. Heavy bleeding can occur if the varices tear. Any type of long-term (chronic) liver disease can cause esophageal varices.
How doctors diagnose it
Your health care provider will do a physical exam. It may show bloody or black stool, low blood pressure, a rapid heart rate, and signs of chronic liver disease or cirrhosis.
Tests can find the source of the bleeding and check if there is active bleeding. One is an EGD, or upper endoscopy, which uses a camera on a flexible tube to look at the esophagus and stomach. Another is a tube passed through the nose into the stomach, called a nasogastric tube, to look for signs of bleeding.
Some providers suggest an EGD for people who are newly diagnosed with cirrhosis. This test checks for esophageal varices.
Treatment
The goal of treatment is to stop acute bleeding as soon as possible. Bleeding must be controlled quickly to prevent shock and death. If massive bleeding occurs, a person may need to be put on a ventilator, a breathing machine, to protect their airway.
To stop the bleeding, the provider may pass an endoscope, a tube with a small light at the end, into the esophagus. A clotting medicine may be injected into the varices. A rubber band may be placed around the bleeding varices. This is called banding, and it is the most common endoscopic treatment for esophageal varices.
A medicine to tighten blood vessels may be given through a vein, such as octreotide or vasopressin. Rarely, a tube is inserted through the nose into the stomach and inflated with air to press on the bleeding veins.
Once the bleeding is stopped, other varices can be treated to prevent future bleeding. This can include beta blockers, which are medicines that reduce pressure in the portal vein (the vein that carries blood from the gut to the liver) and the risk of bleeding. Banding may also be done again during an EGD.
Another option is a TIPS, which creates new connections between two blood vessels in your liver. This can decrease pressure in the varices. A shunt can also send more toxins to the brain and cause hepatic encephalopathy, which can change a person's mental state.
Treating the causes of liver disease may prevent bleeding. Some people may need a liver transplant. Bleeding often comes back with or without treatment.
When to see a doctor
Call 911 or go to the emergency room right away if you vomit blood, have black, tarry, or bloody stools, faint, or have bleeding that will not stop.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Such a doctor can help with follow-up for liver disease and coordinate care with a gastroenterologist or hepatologist. Bleeding needs emergency care.
Common questions
Are esophageal varices serious?
Yes. Bleeding esophageal varices are a serious complication of liver disease and have a poor outcome. Bleeding must be controlled quickly to prevent shock and death.
Do esophageal varices always cause symptoms?
No. People with chronic liver disease and esophageal varices may have no symptoms. Dark or black streaks in the stools may be the only sign of a small bleed.
What is the most common cause of esophageal varices?
Cirrhosis of the liver is the most common cause. The scarring cuts down on blood flowing through the liver, so more blood flows through the veins of the esophagus.
Can esophageal varices bleed again after treatment?
Yes. Bleeding often comes back with or without treatment. Treating the causes of liver disease may prevent bleeding.
Sources
- MedlinePlus - Bleeding esophageal varices
- National Institute of Diabetes and Digestive and Kidney Diseases - Treatment for Cirrhosis
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
