【Learning Points】
  • Esophageal varices bleeding usually don’t have symptoms at first, and only develop symptoms such as tarry stool or vomiting blood when it gets serious.
  • Treatment of esophageal venous aneurysm bleeding: drug treatment, Sengstaken-Blakemore tube, Esophagogastroduodenoscopy, and surgical treatment.
  • Care after treatment should include a bland diet, avoid fatigue and straining maneuvers, take medicine and return to the OPD for follow-up, attention to rebleeding signs.
 
I. What is esophageal varices?
Esophageal varices are a common and dangerous complication of liver cirrhosis. They are caused by portal hypertension. As portal pressure rises, the esophagogastric veins dilate and distend (Figure 1). These engorged and dilated veins are called varices. Esophageal varices can rupture and cause severe hemorrhage. They usually occur at the lower part of the esophagus.
2542d0ff475756d46f228bd0f11a520b.png
(Image: Hand-drawn diagram)

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All information above has been reviewed by Gastroenterology specialists Edited and published by the Department of Nursing, Taichung Veterans General Hospital
 
II. What are the symptoms of bleeding esophageal varices?
In the early stages, there are often no noticeable symptoms. However, if the bleeding becomes severe, patients may develop symptoms such as vomiting blood or passing black, tarry stools.
f0d8e369ef119687da2799fa07c10170.png67791e459f586321b8db1ce19073f927.png49fc958b172653184c3382f5f5ecb1cf.png
(Image generated by Gemini AI)

III. How to manage ruptured esophageal varices?
  1. Medication Therapy:
    Administer vasopressin (Glypressin/Sandostatin) to decrease portal pressure.
  2. Sengstaken-Blakemore tube (SB tube):
    Insert a Sengstaken-Blakemore tube to compress the bleeding varices.
    40f8aef00e25fdcdbd01acf8d52cbbdf.png

    (Image: Hand-drawn diagram)

  3. Esophagogastroduodenoscopy (EGD):
    1. Inject a sclerosing agent (e.g., Histoacryl) during an endoscopy to cause venous thrombosis and fibrosis.
    2. Wrap elastic bands around the esophageal varices during an endoscopy.
  4. Surgical Treatment:
    Due to advances in prophylactic endoscopic injection sclerotherapy and ligation, surgical treatment is rarely performed.

IV. Dietary Principles after esophageal varices bleeding:
You must fast (take nothing by mouth) during the acute bleeding phase. Do not eat immediately following your treatment. Your healthcare team will assess your condition and tell you when it is safe to resume eating.
Once you start eating, please follow these guidelines:
  1. Bland Diet:
    Non-irritating, easy to chew, and easy to digest.
    025eea84df88661e12a9daa39193fbab.png

  2. Gradually Adjust Food Texture:Lquid diet ➡️ Soft diet
    818d24e24bfeaad4aa41d1c36b29249e.png

  3. Eat slowly and chew thoroughly
    6445e06f7196595f9aa49c424eb70894.png

  4. Crush medications for 2-3 days
    ea64a084d8c821a9ccaba88a87e21b03.png
    (Image generated by Gemini AI)

  Direction Example
Liquid diet Based on normal foods, blended
 or puréed into a liquid or thick
soup consistency.
Ex:milk, rice water, Oil-free clear soup, juice.
c24e0805654264a3fd57422aaffa8802.png

Soft diet Based on normal foods, but
avoiding hard fruits, vegetables, and nuts.
Ex:gruel, steamed egg, bean curd, pudding、 Vermicelli.
16bf3373614934ee5541eb28d0677cb9.png

  (Image generated by Gemini AI)

V. Care after treatment:
Bland Diet
  • Avoid fried, hard, rough, hot, or cold foods.
  • Avoid irritating foods and beverages, such as alcohol, coffee, spicy, or sour foods.
    7815b07fdcb50ece428ee68254690ee9.png

Avoid fatigue
  • Maintain a regular lifestyle and a stable mood.
    1cd36d61681fb6b9400997af49ca4518.png
Avoid straining maneuvers
  • Ensure smooth bowel movements (at least once a day),avoid straining when passing stool, and pay attention to the color of stool.
  • Avoid violent coughing and heavy lifting.
    c209dfbba25288ca9568cfbfce289684.png
Take medicine and follow up
  • Take medicine by doctor’s order.
  • Return to the clinic for your follow-up appointments after discharge.
    98cab0ff28697fde0cc3355d9cfaa7e3.png
Pay attention to rebleeding signs
  • If any of the following signs appear,go to the hospital immediately:
    fever, pale skin, rapid breathing,rapid heartbeat, agitation,black/tarry stools, or vomiting blood.
    825cb337032b4fe1d5a6d4f4b43b6eca.png
(Image generated by Gemini AI)

VI. Conclusion
Esophageal varices require ongoing monitoring and repeated treatments. During this time, the risk of bleeding remains. To reduce the risk of rebleeding, patients should maintain a healthy lifestyle, take medications as prescribed, attend all follow-up appointments, and manage underlying conditions such as liver cirrhosis or tumors.
 
VII. Reference
  1. Kaplan, D. E., Ripoll, C., Thiele, M., Fortune, B. E., Simonetto, D. A., Garcia-Tsao, G., & Bosch, J. (2024). AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis. Hepatology, 79(5), 1180–1211.
  2. Singh, S., Chandan, S., Vinayek, R., Aswath, G., Facciorusso, A., & Maida, M. (2024). Comprehensive approach to esophageal variceal bleeding: From prevention to treatment. World Journal of Gastroenterology, 30(43), 4602–4608.
  3. Taichung Veterans General Hospital. (2024). Patient dietary manual [病人飲食手冊]. Retrieved from https://reurl.cc/laqE3A
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    資料夾名稱
    English
    上傳者
    吳雪瑛
    單位
    中榮護理衛教
    英文名稱
    How to Prevent Esophageal Varices from Hemorrhage
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    癌症照護
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    2024-01-29 14:27:55
    最近修訂
    2026-03-12 14:41:05
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    2026-03-12
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