Pediatric esophageal varices

What are pediatric esophageal varices?

Pediatric esophageal varices are abnormal, enlarged veins in the esophagus, the tube where food and fluids pass from the throat to the stomach. The swollen veins are like varicose veins, which can develop in older people’s legs. Pediatric esophageal varices can burst and bleed because they are close to the surface of the esophagus.

Often, children don’t experience signs or symptoms of pediatric esophageal varices unless they bleed. If bleeding does occur, seek immediate medical care for your child because esophageal bleeding can be life-threatening.

What are the signs and symptoms of pediatric esophageal varices?

The signs and symptoms of pediatric esophageal varices can include:

• Feeling lightheaded (dizzy) or passing out

• Passing black, tarry or bloody stools (feces)

• Urinating less due to low blood pressure

• Vomiting blood

Your child’s doctor may suspect esophageal varices if your child has liver disease or its signs and symptoms, which include:

• Enlarged liver or spleen

• Fatigue (tiredness) all the time

• Fluid buildup in their abdomen (belly), called ascites

• Yellowish color of the skin and whites of the eyes (jaundice)

How are pediatric esophageal varices diagnosed?

At Children's Health℠, our pediatric gastroenterologists (doctors who specialize in digestive disorders) begin with a physical exam of your child. We also ask you about your child’s symptoms and their personal and family medical history.

Based on our evaluation, we may order some tests to help confirm a diagnosis of esophageal varices. Your child may need one or more tests, which include:

• Upper endoscopy. Our doctors guide a narrow, flexible tube with a light and camera (endoscope) through your child’s mouth and throat. We look inside the esophagus for swollen veins or bleeding. Your child will receive anesthesia (medicine to help them feel no pain and put them in a sleep-like state) before the procedure. We can often treat esophageal varices during the same procedure. Learn more about therapeutic endoscopy.

• Ultrasound. This imaging uses sound waves to create pictures of the inside of the body. An ultrasound shows details of the esophagus and liver to look for signs of swollen veins, bleeding or liver diseases.

What causes pediatric esophageal varices?

In children, esophageal varices often result from a serious liver disease. They can develop when blood flow to your child’s liver is blocked, usually by scar tissue from liver disease. Rarely, esophageal varices can also develop if the portal vein (the main vessel in the liver) is blocked by a blood clot. As blood backs up in the liver’s main blood vessel, the pressure inside it increases.

Because of the higher blood pressure, more blood flows through the smaller, more fragile blood vessels in the lower part of the esophagus. The increased blood flow causes these vessels to swell, and sometimes, the vessels can burst and bleed.

How are pediatric esophageal varices treated?

The main goal of treatment is to prevent esophageal varices from bleeding. At Children’s Health, our pediatric gastroenterologists offer all available treatments for esophageal varices, both to prevent bleeding and to treat emergency bleeding.

Treatment to prevent esophageal varices from bleeding

Treatments to help prevent esophageal varices from bursting and bleeding include:

• Medication. Our doctors may prescribe medicine to reduce the high blood pressure in the liver veins.

• Sclerotherapy. During an endoscopic procedure, we inject a liquid solution into the varices, which causes them to collapse. This treatment forces blood to go through other, healthier veins.

• Band ligation. This treatment can also take place during an endoscopic procedure. Our doctors insert instruments through the endoscope to wrap the varices with special elastic bands. Banding the veins cuts off blood flow through the veins so that they cannot bleed.

Treatment for esophageal varices that are bleeding

If your child is already bleeding from esophageal varices, our experienced gastroenterologists provide emergency care to stop the bleeding. These treatments include:

• Band ligation. We can also perform ligation to stop bleeding from esophageal varices.

• Surgery. Some children may need surgery to stop bleeding.