Esophageal varices are primarily caused by which condition?

• A. Liver failure
• B. Portal hypertension
• C. Alcoholism
• D. Gastric reflux

Answer: (B)

Portal hypertension is the key driver of esophageal varices. When pressure in the portal venous system rises, blood is diverted through collateral pathways to the systemic circulation, including the veins in the lower esophagus. These esophageal veins dilate and become varices, which are prone to rupture and life-threatening bleeding. Liver disease—such as cirrhosis—often causes this increased portal pressure, making it the common underlying source. Alcoholism can contribute by damaging the liver, but it’s not the direct cause of the varices itself. Gastric reflux has no role in raising portal pressure or forming esophageal varices.