Risk factors

Although many people with advanced liver disease develop esophageal varices, most won't have bleeding. Esophageal varices are more likely to bleed if you have:

• High portal vein pressure. The risk of bleeding increases as the pressure in the portal vein increases (portal hypertension).
• Large varices. The larger the esophageal varices, the more likely they are to bleed.
• Red marks on the varices. When viewed through a thin, flexible tube (endoscope) passed down your throat, some esophageal varices show long, red streaks or red spots. These marks indicate a high risk of bleeding.
• Severe cirrhosis or liver failure. Most often, the more severe your liver disease, the more likely esophageal varices are to bleed.
• Continued alcohol use. Your risk of variceal bleeding is far greater if you continue to drink than if you stop, especially if your disease is alcohol related.

If you've had bleeding from esophageal varices before, you're more likely to have varices that bleed again.