Hi, How are you? My name is Dr Suresh Raghavaiah and I am a liver transplant surgeon. Thanks for writing to HCM and I hope to answer your question today. Hepatitis C virus, as I am sure you are aware, damages the liver cells. The liver has an enormous capacity to regenerate, meaning if part of the liver is damaged, then new liver cells are formed to replace the damaged liver (unlike skin where damaged skin is replaced by scar). The problem with hepatitis C is, it is present constantly in the blood and liver and continues to damage the liver continuously. Just like a rubber band can be stretched only so far before it snaps, so is the regenerative capacity of the liver. Depending on how virulent the hepatitis C strain is, over the course of 10-30 yrs, the liver exhausts its capacity to regenerate and just like skin, the damaged liver cells starts getting replaced by scar tissue - this leads to hardening of the normal supple liver - A condition known as Liver fibrosis which later on leads to liver cirrhosis. the problem with this is, under normal circumstances anywhere between 1200 to 1500 ml of blood flows through the liver per min. When the liver is normal and supple, this blood can flow easily through the liver. But when the liver begins to stiffen or harden as in the case of cirrhosis, this blood is met with great resistance during its flow through the liver. This is called as Portal Hypertension . So the blood starts to look for alternate routes to return to the heart and the most accessible route for it is through the veins of the food pipe (esophagus and stomach). The problem with this is, the veins in the esophagus and stomach are very thin walled and are not used to carrying this much volume of blood. So they distend to a great degree (a condition called as varices) and sometime even rupture with catastrophic consequences. This is easily diagnosed by upper GI endoscopy where the largely dilated veins can be seen. But in your case, since multiple upper GI endoscopies have not demonstrated any varices, it means your liver has not reached a state of portal hypertension yet and the disease seems not be be progressing or is stable . If I was your doctor, I would also get a fibroscan which is a special scan of the liver to look at the amount of stiffness or hardening of the liver. This can be repeated regularly to see the progression of the fibrosis. I would also explore the different treatments for hepatitis C infection. The gold standard is ofcourse a liver biopsy which will demonstrate the exact status of your liver. I hope this helped and I do hope you will get better soon. Plese write back to me if you need any further clarifications especially the treatment options available to treat hepatitis C. Have a great day Dr Suresh Raghavaiah