Esophageal varices most commonly present with which symptom?

• A. Bright red blood in stool
• B. Abdominal pain after meals
• C. Jaundice
• D. Coughing up bright red blood

Answer: (D)

Esophageal varices bleed due to portal hypertension, and the hallmark when they rupture is the rapid emergence of blood in the upper GI tract that is vomited out. This presents as hematemesis, often described as coughing up or spitting up bright red blood, which is why this symptom is the best clue for variceal bleeding. Jaundice reflects liver dysfunction rather than the act of bleeding itself, and bright red blood in the stool suggests a different source of blood loss or a very brisk upper GI bleed but is not the typical presentation. Abdominal pain after meals points to other GI conditions and wouldn’t specifically indicate variceal rupture. So the most characteristic presentation is vomiting bright red blood due to an upper GI bleed from ruptured esophageal varices.