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Stomach varices and portal hypertensive gastropathy | CION Cancer Clinics
Stomach varices are swollen veins in the stomach wall that can bleed heavily. Portal hypertensive gastropathy is a change in the stomach lining that usually oozes slowly and lowers the blood count. Both come from high pressure around a scarred or tumour-affected liver. This page explains how they differ, how each is treated, and which signs mean going to hospital today. At CION Cancer Clinics, our team supports patients and families through symptoms, follow-up and life during and after treatment.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- What are stomach varices and portal hypertensive gastropathy?
- What your endoscopy report might be describing
- How are stomach varices and gastropathy treated?
- How stomach varices and gastropathy differ
- What families often think, and what is actually true
- What this page cannot tell you
- Common questions about stomach varices and gastropathy
The short answer
What are stomach varices and portal hypertensive gastropathy?
Stomach varices are swollen veins in the wall of the stomach, and they can bleed heavily. Portal hypertensive gastropathy is a different change in the stomach lining that usually oozes slowly, causing a low blood count rather than a sudden bleed. Both come from the same cause: high pressure in the veins around a scarred or tumour-affected liver.
That pressure is called portal hypertension. Blood that cannot flow easily through the liver backs up into the veins of the food pipe and stomach. Most people have heard of varices in the food pipe, which are covered on varices explained. Stomach varices are less common, sit deeper in the wall, and are treated differently.
Why the difference matters to you
A report that says stomach varices means the doctors will plan carefully to stop a large bleed. A report that says portal hypertensive gastropathy, or PHG, usually means watching your blood count and iron. The words sound alike on an endoscopy report, so it is worth asking which one you have.
Neither finding is cancer. Both are signs that the liver is under strain.Telling them apart
What your endoscopy report might be describing
The doctor doing the endoscopy looks at where the veins sit and what the lining looks like. Each finding below leads to a different plan.
Varices that run from the food pipe into the stomach
These are the most common kind of stomach varices. They continue from food pipe varices across the join with the stomach. They are often treated in much the same way as food pipe varices.
Varices in the upper stomach only
Veins that sit in the upper, rounded part of the stomach, called the fundus, bleed less often but can bleed heavily. They are harder to band and usually need a different treatment.
A grading system developed in India is widely used to describe where stomach varices sit.Portal hypertensive gastropathy
The stomach lining looks patterned, like snake skin or a mosaic, because its small blood vessels are swollen. It tends to leak small amounts of blood over a long time.
- Tiredness and breathlessness on stairs
- Pale skin, low iron on a blood test
- Sometimes dark stools
A look-alike called watermelon stomach
Red stripes in the lower stomach can look similar to gastropathy but are not caused by the pressure. Lowering the pressure does not help it, so the endoscopist needs to tell the two apart.
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Go to hospital today, by ambulance if you can
Vomiting blood, vomit that looks like coffee grounds, black sticky stools, fainting, a racing heart or sudden paleness can mean stomach varices are bleeding. A bleed from stomach varices can be large. Do not wait to see if it settles. Call an ambulance or go to the nearest emergency department now and tell them the person has liver disease and varices. Read vomiting blood is an emergency before you need it.
How they are treated
How are stomach varices and gastropathy treated?
Lowering the pressure
A daily beta-blocker tablet, such as propranolol or carvedilol, is used for both conditions in many people. It lowers the pressure that feeds the veins and the leaky lining. The hepatologist decides whether it suits you.
Sealing stomach varices from inside
Instead of bands, the endoscopist may inject a medical glue into the vein to block it. This is skilled work and is done in centres used to it. CION coordinates this through accredited partner hospitals.
Blocking or bypassing from outside
An interventional radiologist can block the varices through a vein in the groin, or place a TIPS shunt inside the liver to lower the pressure. These are chosen when glue is not enough or not suitable.
Treating the oozing lining
For gastropathy, the focus is iron tablets or iron through a drip, the beta-blocker, and sometimes a blood transfusion. Endoscopic treatment is rarely needed for the lining itself.
Fitting it around cancer treatment
The tumour board reviews the endoscopy before cancer treatment that affects bleeding. See bevacizumab and bleeding risk.
Side by side
How stomach varices and gastropathy differ
Stomach varices
Portal hypertensive gastropathy
Swollen veins in the stomach wall
Swollen small vessels in the stomach lining
Bleeds less often, but can bleed heavily
Usually oozes slowly over time
Often treated with glue, a shunt or blocking the vein
Treated with iron, a beta-blocker and watching the blood count
Sudden vomiting of blood is the main danger
Tiredness from a low blood count is the usual sign
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Commonly believed
What families often think, and what is actually true
"It is only in the stomach, so it is less serious than varices in the food pipe."
Stomach varices bleed less often, but when they do the bleed can be heavier and harder to stop. They need the same respect and the same emergency plan.
"Gastropathy means an ulcer, so antacids will heal it."
It is not an ulcer and acid is not the cause. The pressure is. Antacids may be given for other reasons, but the plan for gastropathy is iron and pressure control.
"He is tired because of the cancer, nothing can be done."
Slow bleeding from the stomach lining can cause a low blood count, which is very treatable. A simple blood test can show it, and iron can make a real difference to energy.
"A herbal liver tonic will shrink the veins."
No tonic lowers portal pressure, and some can injure a cirrhotic liver. Tell your doctor what you take without worrying about being judged, so they can check it is safe.
Being straight with you
What this page cannot tell you
It cannot tell you what your own endoscopy shows, or how likely your stomach varices are to bleed. That depends on their size and position, how weak the liver is, and whether a tumour is blocking the portal vein or the vein from the spleen. The hepatologist who saw them is the right person to ask.
Who this does not apply to
If your report mentions only food pipe varices, the page on preventing a second bleed is closer to your situation. Some people have stomach varices with a healthy liver, because a clot or a pancreatic problem has blocked the vein from the spleen. The cause and the treatment are then different, and this page only partly applies.
Who looks after what
Endoscopy, glue injection and shunts are arranged with hepatologists and interventional radiologists at partner hospitals. The CION medical oncologist keeps the bleeding risk in view when choosing cancer treatment, so the two plans work together.
If your endoscopy report is confusing, bring it to your next CION visit and ask us to explain each line.Questions we are asked
Common questions about stomach varices and gastropathy
Are stomach varices more dangerous than food pipe varices?
They bleed less often, but a bleed from them can be heavier and harder to control. That is why they are treated with care and why the emergency plan is the same. Vomiting blood or black stools always means going to hospital today, wherever the varices are.
Can stomach varices be banded like food pipe varices?
Those that run on from the food pipe sometimes can. Those in the upper stomach usually cannot, because the veins are large and deep. They are more often sealed with a medical glue injected through the endoscope, or treated by an interventional radiologist.
Is portal hypertensive gastropathy cancer?
No. It is a change in the blood vessels of the stomach lining caused by high pressure from the liver. It does not turn into cancer. Its main effect is slow blood loss that can leave you tired and short of iron, which can be checked and treated.
Why do I keep needing iron or blood?
The lining of the stomach can ooze small amounts of blood day after day, which you may never see. Over time this lowers the blood count. Iron replaces what is lost, and the beta-blocker can reduce the oozing. Your doctor will track the blood count at each visit.
What is glue injection?
It is a treatment given during an endoscopy, under sedation. A medical glue is injected into the vein and sets almost at once, blocking it from the inside. It is done by endoscopists experienced in it. Your team will explain where it takes place and what to expect afterwards.
Do I still need a beta-blocker?
Often yes, because it lowers the pressure behind both the varices and the gastropathy. It does not suit everyone, including some people with low blood pressure, kidney problems or fluid that keeps coming back. The hepatologist will decide, and you should never stop it without asking.
Does liver cancer change the plan?
It can. A tumour that blocks the portal vein can raise the pressure and make varices worse. Some cancer medicines affect bleeding. The tumour board looks at the endoscopy findings before choosing treatment, and the varices are usually controlled first.
Where do I start if my report mentions stomach varices?
Keep the report with you, make an emergency plan with your family, and book a review with the hepatologist who arranged the endoscopy. If you also have liver cancer, bring the report to your CION oncologist. Call the CION helpline if you are unsure who to see first.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- Merck Manual Consumer Version — Portal Hypertension
- MedlinePlus — Bleeding esophageal varices
- NHS — Vomiting blood
- RadiologyInfo.org (RSNA/ACR) — TIPS - Transjugular Intrahepatic Portosystemic Shunt
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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