Varicose veins of the esophagus are a disease of the gastrointestinal tract that occurs due to the presence of pathologies of this organ system in a person, as well as against the background of the development of other diseases. Treatment can be medication, surgery and depends on the severity. The prognosis is unfavorable: the disease is incurable and shortens the patient’s life by several years.
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Varicose veins of the esophagus are a pathology of the veins, which manifests itself in the form of tortuosity and saccular dilations against the background of the formation of phleboectasis (dilated veins on the patient’s skin). This disease occurs in adults and children. The cause of this disease is increased pressure in the portal vein, hypertension (increased blood pressure) or congenital pathology. Pressure in the portal vein system occurs with cirrhosis of the liver, tumors of the liver and pancreas, venous thrombosis or developmental abnormalities.
Blood is discharged from the portal vein system through the vessels of the stomach into the veins of the esophagus and because of this the pressure increases. Due to the fact that they are thin, when overloaded with a large volume of blood, they stretch and varicose veins form. If liver damage is noted, then varicose nodes are located in the lower part of the esophagus and at the entrance to the stomach, and with systemic hypertension, the nodes are located along the entire length of the organ.
This pathology can occur against the background of such reasons and factors as:
The risk group includes males over 50 years of age.
The main symptom of this pathology is the presence of bleeding from the veins of the esophagus. Patients complain of a feeling of pressure and heaviness behind the sternum. Sometimes, before bleeding begins, esophagitis appears - inflammation of the mucous membrane of the esophagus, in which it becomes loose and is easily damaged by solid food.
There is a burning sensation, heartburn, rapid heartbeat (tachycardia), sour belching and difficulty swallowing solid foods. The normal level of pressure in the esophageal veins is no more than 15 mmHg, and with varicose veins it reaches a level of 25 mmHg. Bleeding occurs after exercise, overeating and during sleep.
Minor blood loss can lead to exhaustion and anemia. They are accompanied by the presence of streaks of blood in the vomit, weakness, and nausea. There is black stool due to coagulated blood and weight loss.
With massive bleeding, bloody vomiting, weakness, impaired consciousness and paleness of the skin are observed. Increased sweating is noted, and the patient’s blood pressure decreases while the heart rate (heart rate) increases. This disease has two forms: congenital and acquired. The acquired disease occurs against the background of previously suffered somatic pathologies, which led to dilation of the veins.
According to the endoscopic classification, which was proposed in 1983, there are 4 stages (degrees) of esophageal varicose veins, each of which is characterized by its own symptoms:
Below is a microscopic specimen of dilated veins of the esophagus:
Diagnosis of the disease is carried out on the basis of anamnesis, patient complaints, laboratory and instrumental research methods. There is a decrease in hemoglobin level due to bleeding. Using ultrasound and MRI (magnetic resonance imaging) of the liver, it is possible to determine the underlying disease that led to the dilation of the veins of the esophagus.
An x-ray of the esophagus is used using a contrast agent. It helps to determine the narrowing and deformation of the vascular walls. Using esophagogastroduodenoscopy (a research technique using an endoscope), bluish nodular protrusions of veins can be detected. Thanks to endoscopy, the doctor can make a correct diagnosis and determine the degree of pathology.
Depending on the course of the disease, the patient may be treated in the department of gastroenterology or surgery. A gastroenterologist treats the underlying disease and prevents bleeding. For this purpose, the doctor prescribes hemostatic drugs (Immunat, Traskolan, Respikam), antacids (Vicair, Almagel) and vitamins.
You should follow the correct diet, rest and physical activity. If the patient experiences bleeding, a Blackmore probe is inserted to stop it. This device has balloons that, when inflated, block the lumen of the esophagus and compress the vessels. The disadvantage of this method is that in 40-60% of cases there is no positive effect.
After the bleeding has been stopped and the patient's condition has been stabilized, surgical intervention is used. Doctors place shunts (vascular grafts) between the portal vein and the bloodstream. Because of this, the pressure in the portal vein decreases.
The most common treatment for this disease is the endovascular transjugular shunt method (through the jugular vein). In addition, they resort to anastomoses (connection of hollow organs), removal of the spleen and esophageal veins. Sometimes vein ligation or suturing is used.
The diet of such patients consists of boiled or steamed food. It is recommended to eat pureed food. Dishes should not be cold or hot. Meals should be fractional (5-6 times a day) and in small portions.
Therapy with folk remedies at home is used as an addition to the main treatment in order to increase efficiency. Popular recipes:
The prognosis of the disease is unfavorable. This pathology is considered incurable, but therapy must be carried out to prevent recurrent bleeding. When the first bleeding occurs, the patient's life is shortened by 3-5 years.
Prevention of this disease lies in the timely detection of pathologies of the gastrointestinal tract (gastrointestinal tract) and their treatment. If the patient suffers from cirrhosis of the liver, then he should be constantly monitored by a gastroenterologist and avoid physical activity and heavy lifting. In order to prevent reflux (reflux of stomach contents into the lumen of the esophagus), it is recommended to raise the head of the bed during sleep.
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The non-medical public usually discusses what varicose veins are in relation to the lower extremities. But few ordinary people know that varicose veins of the esophagus occur. To understand what this disease is and what symptoms are characteristic of it, you should have an idea of the blood supply to the esophagus as a whole. And if the veins in it dilate, what reasons can provoke this.
The blood supply to the esophagus is organized by a large number of different vessels. The upper esophagus is supplied with blood through large vessels: the left subclavian and superior esophageal arteries. Additionally, the arterial branches of the bronchi and thoracic aorta participate in the blood supply to the upper section.
The venous plexuses of the esophagus are complex. The outflow of venous blood goes in two directions - descending and ascending. The system connecting the veins to each other is called portocaval anastomosis. It is in their area that varicose veins of the esophagus most often occur.
The International Classification of Diseases, 10th revision, which is used by modern doctors, distinguishes two types of disease:
The form distinguishes between congenital and acquired disease.
It is very rare, but is still described in the medical literature. Typically, babies with a congenital condition suffer from many additional serious conditions.
This form is loved by the population who have crossed the 50-year mark. Moreover, in males the disease has a ratio of 2:1 compared to females.
An analogy immediately arises of the connection between the causes of the disease and male bad habits (overeating, smoking, alcohol abuse). However, these are just analogies.
The causes of the disease are known to gastroenterologists.
The main causes of the development of the disease are associated with a special pathological condition - portal hypertension. It is this that increases the pressure in the portal vein, which causes the walls of the vessel to expand and thinner.
There are several more specific reasons leading to varicose veins:
All of these pathologies require timely and regular treatment.
There is an endoscopic classification (ERVP), which distinguishes 4 degrees.
It is unlikely that you will be able to recognize the disease on your own in the early stages, since symptoms of esophageal varicose veins are absent until a certain period or are skillfully disguised as other diseases.
Initially, the patient may be bothered by the following symptoms:
But their presence is not always noted. A distinctive and striking sign of VRVP is an enhanced vascular pattern on the chest, called the head of a jellyfish. But it does not appear immediately, but only at serious stages of the disease.
Most often, symptoms become indicative in connection with the onset of bleeding from diseased veins.
In this case the following appears:
If the bleeding is massive, it poses a real threat to the patient's life. With light bleeding, patients quickly develop anemia, which causes severe weakness, weight loss, shortness of breath, decreased blood pressure, and palpitations.
Treatment of pathology is, first of all, always aimed at eliminating the provoking disease that has led to changes in the esophageal veins - hepatic pathologies, heart and vascular diseases, etc. Treatment of varicose veins directly is preventative - the task of doctors is to prevent bleeding.
A lot depends on the person who has been diagnosed with varicose veins. He must completely change his regime, understanding the danger of the disease. High physical activity should not be allowed; diet and regimen should be carefully followed.
Treatment with medications involves the use of drugs for the underlying disease, and vitamin preparations, antacids, and astringents can be used to eliminate associated symptoms.
In case of minor bleeding, conservative treatment is provided:
Surgical treatment for bleeding is more effective than using conservative methods. The indicator is the statistical indicators of mortality - when using surgical methods of treatment, it is 3 times lower.
Patients must be aware that this pathology is incurable and carries a strong threat of death from bleeding, therefore, if the disease is detected in a timely manner, follow all recommendations for supportive treatment.
If we consider the mortality rates from bleeding in varicose veins, the numbers do not look reassuring. More than half of the patients die, this is largely due to the severity of the underlying disease. Such indicators once again convince of the need for adequate treatment of the underlying pathology.
The most accurate diagnostic method is esophagoduodenoscopy. It is he who helps determine the degree of the disease and the likelihood of bleeding. Among instrumental methods, ultrasound diagnostics and contrast radiography of the esophagus are also used. Conduct blood tests - general and biochemical tests.
Dieting is included in a separate section precisely because of its exceptional importance. The fact is that exposure to cold or irritating food significantly increases the risk of bleeding, so patients with symptoms of the disease should absolutely not eat it.
There are a few more rules for catering that must be followed:
As you can see, such a diet presupposes a complete revolution of the regime. Now you need to think about food, this is the guarantee that surgical treatment will not be needed.
Now about foods that should not be consumed.
Even if you find it extremely difficult to give up your favorite foods, this is a vital measure. The poor survival rates after bleeding should convince you of this. After all, despite the successful outcome of the operation, which you could not avoid, in almost 70% of cases, a relapse occurs after a couple of years, and the bleeding recurs. Therefore, it is much easier to simply prevent it.
The most common reasons are:
If phlebectasia is accompanied by arterial hypertension, this indicates chronic heart failure. In practice, there are cases of congenital varicose veins of the esophagus.
Blood pressure in the portal vein system has consistently acceptable limits, exceeding which by 3-4 times over a long period of time leads to the development of varicose veins of the esophagus. In this case, a violation of the outflow of blood occurs, as a result of which deformation of the blood vessels is observed: the veins change their shape, size, and structure.
Esophageal varicose veins at the initial stage of development involve changes in the distal part of the esophagus, and with further development, damage is observed along the entire length of the organ. With sudden changes in pressure, serious complications can occur in the form of esophageal bleeding. Moreover, the likelihood of complications depends on the range between low and high pressure levels. The causes of esophageal bleeding can be physical activity, diseases of the gastrointestinal tract, and increased blood pressure.
Regularly recurring light bleeding leads to a complication such as iron deficiency anemia. In this case, the patient experiences weakened immunity, weakness, physical inactivity, hypotension, and sudden and significant weight loss. But profuse bleeding can be fatal.
Recent studies have shown that varicose veins of the esophagus are observed mainly in the male population aged 45-50 years. In most cases, esophageal varicose veins develop asymptomatically or are characterized by symptoms of the underlying disease.
As practice shows, similar symptoms were observed in patients with esophageal varicose veins:
Characteristic symptoms of the disease are bloody vomiting, dark stools, hypotension, tachycardia, and in critical cases, collapse.
Based on the patient’s complaints, the doctor conducts a comprehensive examination to confirm or exclude esophageal varicose veins. The specialist performs fibroesophagoscopy, the results of which reveal:
Often the cause of bleeding can be developing eosinophilic gastroenteritis.
Timely diagnosis of the disease is important for the patient. In this case, it becomes possible to avoid esophageal bleeding and prevent death. Esophageal varices are treated both conservatively and with surgical intervention, and the second method of treatment involves reducing mortality among patients by approximately 3 times.
Conservative treatment is carried out using:
Surgical treatment involves a liver transplant as a last resort, since such an event is possible only in the last stages of the disease. An effective measure is to remove damaged veins that cause bleeding. The main factor of these procedures is efficiency and suddenness, since the patient’s life depends on these factors.
Varicose veins of the esophagus is a rather serious disease, since it entails a high mortality rate (about 45-50%). Many patients observe a spontaneous cessation of bleeding, and patients who have overcome this terrible disease are required to undergo regular annual courses of therapy. But even in this case, the outcome of the disease is minimal, since such patients have a short life span.
Varicose veins are currently a widespread pathology and one of the main causes of early disability. Although most patients experience the development of this disease in the pelvic area and lower extremities, varicose veins of the esophagus are extremely dangerous manifestations of this vascular lesion. Deformation of the veins supplying blood to the upper parts of the digestive tract rarely occurs as an independent pathological process. A similar anomaly can occur in a patient mainly as a clinical manifestation of dysfunction of various organs and systems of the human body.
The term “phlebectasia” is widely used in the medical community, which means little to the average person. With this Latin expression, experts refer to the deformation and change in function of the walls of the vessels that supply the esophagus and stomach with blood.
Doctors believe that the trigger for the development of such a pathology is an increase in pressure in the portal vein, which is one of the main blood vessels of a person. A change in the throughput of this line leads to stagnation in the vessels of the esophagus and stomach, which is the main reason for the change in the extensibility of their walls.
The mucous membrane covering the muscle layer becomes inflamed, nodes and bulges appear in the veins, which in turn increases blood stagnation and leads to disruption of the nutrition of the cells of the digestive organs. Quite often, this restructuring process takes a long time and occurs without external manifestations. It is the erased picture of the disease that poses the main threat to the patient.
If a patient is diagnosed with varicose veins of the esophagus, the causes of such a problem may be the following:
The main causes of varicose veins of the esophagus
All such disorders lead to the development of portal hypertension, without which the occurrence of esophageal varices is unlikely.
Changes in the vascular wall of the digestive organs can also be a consequence of cardiovascular failure, but in this case the clinical picture of the disease is different: pathology in the vessels is detected throughout the esophagus and stomach. In case of liver damage, the main process occurs in the area in the lower third of the esophagus and the cardiac part of the stomach. The nodes themselves with portal hypertension will be much larger.
It should be noted that men are susceptible to this pathology 3 times more often than women. The main age of patients ranges from 45 to 55 years, which makes it possible to clearly determine the risk group for the development of varicose veins. This is due to the fact that representatives of the stronger sex are more susceptible to various concomitant factors, for example, frequent drinking of alcohol, smoking, nervous stress, and heavy physical labor.
As noted above, quite often there are no obvious signs of the disease for a long time, and the first manifestations of the disease appear when the patient develops one of the complications of varicose veins - inflammation of the esophageal mucosa or esophagitis.
For the initial diagnosis of varicose veins of the esophagus, the symptoms are as follows:
Such manifestations of the disease are associated with swelling of the esophageal mucosa and a decrease in its lumen. And since the area of the esophagus and stomach is abundantly supplied with nerve endings of the vagus nerve, the patient may develop heart rhythm disturbances and tachycardia.
In addition to inflammation of the mucous walls of the esophagus and stomach, difficulties with eating and constant dyspeptic symptoms, such a pathology of the vascular wall is fraught with the development of bleeding. Violation of trophism causes fragility of the walls of blood vessels, they burst, and blood pours into the hollow organ.
The intensity of bleeding depends on the diameter of the damaged artery or vein, blood pressure, concomitant pathology and the state of the patient's coagulation system. There are many reasons leading to such complications. This may include:
Most often, bleeding occurs of the capillary type. They are characterized by the taste of blood in the mouth, weakness, nausea, but pass without drug intervention. However, despite its apparent harmlessness, frequent effusions of liquid blood from the dilated veins of the esophagus can lead to the development of anemia, changes in the patient’s electrolyte balance and disruption of the coagulation system.
Since varicose veins of the esophagus are most often a consequence of other diseases, the diagnosis is based on a careful collection of the patient’s life history. If this is a man aged 50, leading a busy lifestyle and abusing alcohol, then the initial picture is already clear. Liver diseases, and especially previous viral hepatitis C, are considered aggravating circumstances.
Laboratory research methods can also be an important aid for differential diagnosis. A biochemical blood test, control of the coagulation system, lipids and blood protein will confirm the preliminary conclusions of specialists. Considering that with varicose veins of the gastrointestinal tract there is a high probability of bleeding, it is mandatory to determine the blood type, Rh factor and time of formation of the blood clot.
Varicose veins of the esophagus (diagnosis by fibroesophagoscopy)
To make a more accurate diagnosis, modern medicine offers quite a lot of methods for instrumental examination of the condition of the esophagus and stomach. X-rays of the esophagus and stomach, as well as ultrasound of problem organs, have proven themselves to be effective for such pathologies. With their help, it is possible to clearly determine the area and degree of damage to the arteries and veins that supply these organs with blood.
The widely used method of fibroesophagoscopy provides the most complete characterization of the affected areas, however, this method requires some caution during manipulation. Inserting a special probe into the esophagus and stomach can damage the compromised mucosa and lead to massive bleeding.
As already noted, varicose veins in the gastrointestinal tract are a consequence of the patient having various pathologies of the liver and cardiovascular system, therefore, during a calm period, all therapy is aimed at treating the underlying disease.
The main and most dangerous manifestation of this disease of the vessels of the esophagus and stomach is bleeding. If a patient is diagnosed with esophageal varices, treatment is primarily aimed at preventing bleeding and combating its consequences.
In medical practice, there are three main directions for solving this problem.
This treatment is used during periods of relative calm and with minor bleeding in the esophagus and stomach. It is based on the use of drugs that relieve inflammation, reduce the level of acidity in the stomach, and maintain vitamin and electrolyte balance in the patient’s body.
If bleeding occurs, transfusion of blood plasma, red blood cells, and vasoconstrictor drugs is possible. All actions of doctors during this period should be aimed at stopping bleeding and combating anemia.
Among the well-known medications, the use of beta blockers, antacids and antispasmodics has received good reviews. Even ordinary nitroglycerin has proven effective against esophageal varicose veins.
Since varicose veins in medicine are classified as surgical pathologies, the main treatment methods have been developed by specialists in this field. Modern surgery offers its patients:
One cannot fail to mention the widespread use of endoscopic interventions. These techniques are indicated primarily for patients for whom full-scale surgery is contraindicated.
In this case, specialists use different methods of surgical interventions. This includes operations from the simplest cauterization of a bleeding vessel to ligation of large sections of damaged veins. The use of special glue, which is used to treat the provoked areas of the veins of the esophagus and stomach, also gives good results.
It should be noted that with the development of medical technology, most surgeons give preference to minimally invasive interventions.
Changes in the venous walls in the esophagus and stomach in various diseases are not a death sentence for the patient. If the process has not entered a critical phase, fatal health problems can be avoided.
When a patient is diagnosed with this, doctors always give their recommendations on lifestyle. First of all, this category of patients should avoid physical activity. Even a short-term increase in blood pressure can provoke bleeding from thinned vessels.
A special diet has been developed for varicose veins of the esophagus. All foods that may cause physical or chemical effects on the walls of the esophagus or stomach are prohibited. All food should be at room temperature, portions cannot exceed 200 - 300 grams, and the frequency of meals can reach 8 times a day.
Varicose veins require the patient to follow all the recommendations of the attending physician, a gentle lifestyle and an appropriate diet. By following these simple rules, you can avoid a terrible complication of this disease - bleeding, which threatens the patient’s life.
During the gestation period, the child may develop a pathology such as phlebectasia of the jugular vein. It can be right, left, both internal veins, moderate. Signs are manifested by protrusion, pulsation when coughing, straining. Treatment is surgery.
Doctors have no such concept as internal varicose veins. However, it refers to pathologies of the veins of internal organs. What are the causes, signs and symptoms of the pathology? How to treat internal varicose veins?
Portal hypertension occurs in adults and children for various reasons, often cirrhosis. It can be either a syndrome or extrahepatic bleeding. There is a certain classification of the disease. Diagnosis includes ultrasound and specific treatment.
Patients with problems with the veins of the lower extremities should under no circumstances be left to chance. Complications of varicose veins of the lower extremities are dangerous due to their consequences. Which ones? Find out in our article.
A change in the vein in the abdomen can be either an alarming signal or a completely natural phenomenon. For example, athletes may experience expansion or swelling during training. If you are pregnant, you should consult your doctor. The reasons are different for women, men, and children; if it hurts, you need to see a doctor.
The SVC or superior vena cava syndrome occurs due to compression due to external factors. Symptoms include dilated veins in the upper torso and bluishness of the face. Treatment consists of removing the symptom complex and treating the underlying disease.
When a problem arises with the vessels and veins in the legs, the patient is offered many treatment options. Cream, gel and ointment for varicose veins can relieve swelling and alleviate the condition.
Varicose veins and thrombovlebitis are so similar, it is not so easy for the average person to understand the difference between them. What signs and symptoms can help you differentiate between them?
Wounds and formations can cause a lot of problems for the patient. If ulcers appear on the legs due to varicose veins, they must be treated urgently. For this purpose, medications, ointments, and herbs are used. Prevention of trophic ulcers in varicose veins is also important.
Varicose veins of the esophagus develop due to a violation of the outflow of blood in the portal and superior vena cava. This pathology is observed in the distal esophagus or proximal stomach. Depending on the nature of its appearance, it can be congenital or acquired. The latter, moreover, depends not on the age of the patient, but on the emerging condition and obstacles to normal blood flow in the portal vein system.
Varicose veins of the esophageal veins are accompanied by portal hypertension of various origins. In this case, the following are distinguished:
Varicose veins of the esophagus at a young age are more often caused by extrahepatic blockade, in adults – intrahepatic.
The causes of the disease are caused by the anatomical connection of the veins of the esophagus with the portal vein system, veins of the abdominal organs, especially the spleen. With the intrahepatic form of blockade of blood flow, the pathology covers the lower parts of the esophagus, the reasons for this are congestive processes in the portal vein of the liver, which occur when:
Extrahepatic blockade of blood flow is explained by thrombosis of the portal vein, compression by tumors, lymph nodes, cysts or stones in the bile ducts. Varicose veins in the upper sections also occur with malignant goiter or angioma of the esophagus, as well as vascular changes with Randu-Osler disease.
More rarely, the disease develops with increased pressure in the systemic bloodstream, which is observed in the case of chronic cardiovascular failure. A typical sign is that vascular nodes in liver diseases are 2-3 times larger.
There is also a congenital form of varicose veins of the esophagus, the causes of which are not clear.
When the outflow of blood from the veins of the esophagus is difficult, they begin to develop dilation, tortuosity and elongation. At the same time, the walls of the vessels become thinner and can rupture, which entails the development of bleeding. The lumens of the venous vessels increase unbalancedly, and local expansions in the form of nodes are formed.
The evolution of the disease can be rapid, or it can proceed extremely slowly. Very often, a disease that appears may not manifest itself in any way for several years. The patient is worried about only some vague complaints, among them:
The approximate age of the patients is about 50 years; there are twice as many men among the patients as women.
The development of bleeding is the most serious complication of varicose veins of the esophagus. It can go unnoticed by the patient, or it can pose a threat to his life. The main symptom is vomiting red blood. Even though they are not dangerous in appearance, they occur unnoticed, but regular blood loss can cause iron deficiency anemia.
The reason for the development of such bleeding can be:
Sometimes such bleeding can occur suddenly in the midst of full health and, if it becomes profuse, lead to death. Its harbingers are a slight tickling in the throat and a characteristic salty taste in the mouth. Soon after their appearance, vomiting of scarlet or coffee-ground-like blood suddenly occurs. Sometimes fibroesophagoscopy leads to bleeding, which indicates the need to diagnose the disease as early as possible.
Varicose veins of the esophagus can be observed in 70% of patients with cirrhosis of the liver. This phenomenon is explained by the fact that with cirrhosis, scar tissue forms in the liver, displacing healthy cells. This slows down the movement of blood and causes stagnation, which causes the development of this pathology in the lower parts of the esophagus. Variceal bleeding causes death in 10-15% of cases in those suffering from cirrhosis. The most dangerous diagnostic sign is early relapses.
For this reason, patients with cirrhosis of the liver should undergo regular endoscopic examinations to detect varicose veins. In the absence of dilatation of the esophageal veins, the frequency of such examinations should be once every 2 years, if present - once or 2 times a year. The frequency and extent of detectable varicose veins is usually proportional to the severity of cirrhosis.
In the treatment of such patients, great importance is attached to the prevention of recurrent bleeding. It is based on the use of drugs that lower portal pressure, endoscopic sclerotherapy and surgical techniques. It should be noted that preventing relapses has worse results than preventing the first episode of bleeding.
The following types of studies are used to make a diagnosis:
The main thing here is to perform fibroesophagoscopy, which makes it possible to establish the causes of bleeding, determine the condition of the venous walls and the degree of dilatation of the veins, and also predict the rupture of the next aneurysm. If bleeding has already begun, its cause may be difficult to determine due to the difficulties in performing effective esophagoscopy.
Some information about the condition of the esophagus and the nature of varicose veins can be obtained on the basis of radiography of the esophagus performed with contrast.
Since the condition of varicose veins is usually associated with severe liver disease, it is important to evaluate the degree of possible coagulopathy. To do this, general blood tests are performed to determine platelets and prothrombin index, as well as liver tests. If bleeding is present, the blood type, Rh factor and cross-test for red blood cell compatibility should be determined.
In differential diagnosis, it is necessary to exclude the possibility of many other diseases, such as:
Treatment of esophageal varices is aimed at eliminating diseases that have led to increased pressure in the portal and vena cava system, as well as eliminating the threat of possible bleeding. Such measures also include the prevention of esophagitis, a gentle lifestyle, and taking medications - antacids, vitamins, laxatives.
If bleeding occurs, the following measures are taken:
To compensate for blood loss, patients undergo blood transfusion, red blood cell infusion or plasma replacement solutions.
In cases of massive bleeding, more serious surgical intervention may be necessary, which can significantly reduce mortality. It has been noted that with conservative treatment, mortality is 3 times higher than with surgical treatment. There are palliative and radical surgical operations to eliminate esophageal bleeding.
Currently, there is significant experience in the use of minimally invasive endoscopic interventions to eliminate bleeding from dilated esophageal veins.
Endoscopic sclerotherapy was first described in 1939. Only in the 70s of the last century, in connection with the development and improvement of endoscopic installations, the intensive introduction of the method into practice began. During it, sclerosants with different mechanisms of action are used. There are 2 ways to perform endoscopic sclerotherapy of the esophagus:
The intravasal method of administering sclerosant involves the development of connective tissue at the location of the thrombosed varicose vein. In recent years, most researchers have refused to carry it out, since it has a significant number of severe complications. Among them are perforation of the esophagus, necrotic and purulent thrombophlebitis.
With the paravasal method, when the sclerosant is injected into the submucosal layer, scarring of the paravasal tissue occurs and subsequent compression of the dilated veins of the esophagus. This method is considered more gentle and has fewer complications.
The use of balloon tamponade helps improve the results of sclerotherapy.
Good results can be achieved by the endoscopic alloying method, which was proposed in 1985. Accordingly, the cessation of blood flow in the dilated veins of the esophagus is performed using alloying rings. Relapses after such an intervention were observed in only 17% of patients, which is almost half as much as after sclerotherapy.
This method helps stop bleeding by squeezing the bleeding node. It is quite dangerous and should only be performed by an experienced specialist. The main instrument is a special probe equipped with a balloon. Stopping bleeding is achieved by inflating the gastric balloon and traction without division.
swelling of the esophageal balloon. Thanks to this, tamponade of varicose veins is produced and the intensity of bleeding from the venous plexus is reduced. Esophageal balloon inflation is performed very rarely due to the risk of possible complications.
The effectiveness of using balloon tamponade is 90%.
The following surgical methods are used to treat this disease:
The TIPS technique consists of creating an intrahepatic artificial channel between the hepatic and portal veins and installing a metal stent in its ducts. Thanks to it, it is almost always possible to stop bleeding, including those that are not amenable to other types of therapy. The main disadvantage of the technique is its high complexity and the obligatory subsequent development of hepatic encephalopathy.
The effectiveness of bypass surgery is close to that of TIPS, but is much more traumatic. The occurrence of hepatic encephalopathy is also a serious problem.
Devascularization operations consist of transection of the esophagus and subsequent anastomosis. A variation is the intersection of the esophagus with splenectomy and ligation of the periesophageal and perigastric veins. This kind of surgery effectively helps stop bleeding without eliminating the causes of portal hypertension, which leads to rapid relapses in the development of this pathology.
The prognosis is determined by the severity of the underlying liver disease. In general, varicose veins have a high mortality rate, exceeding 50%. Mortality is determined not by the severity of bleeding, but by the nature of the liver diseases that led to it.
Although in 80% of patients bleeding stops on its own, mostly patients who have a good functional state of the liver recover, but for patients with severe hepatocellular insufficiency it is often fatal.
In patients who survive bleeding, 75% of cases experience a relapse within the next 1-2 years. Regular drug and endoscopic treatment of varicose veins reduces the risk of this.
In general, the prognosis for long-term survival of patients with this disease remains low, which is mainly due to the underlying severe liver disease.
Quite often, many people who do not have special knowledge in medicine do not know what phlebectasia is. But many people have heard about the synonymous name for this disease – varicose veins of the esophagus. At the same time, I don’t fully understand what symptoms arise, how one should behave, what prevention consists of, and how treatment should be carried out.
Varicose veins of the esophagus are characterized by a pathological process of internal veins, which leads to their deformation. This lesion leads to an increase in the lumen of the venous vessels, which causes the formation of nodes on their walls, which are local extensions. Fleckectasia is observed only in the distal esophagus or proximal stomach.
Veins that have succumbed to the influence of the disease become tortuous, and the membrane located above them is much thinner and more susceptible to irritants. The disease manifests itself in the vein when the blood pressure in it increases.
The main problem of the initial stage of varicose veins is that the patient does not feel any manifestations of esophageal disease. Therefore, turning to a doctor often occurs late, when the degree of development of the disease has already reached its peak.
At this time, the veins begin to bleed because they become too fragile to hold blood inside them. At the same time, the danger to human life greatly increases.
VRVN has relatively high mortality rates due to the fact that severe hemorrhage can begin spontaneously. In addition, this indicator increases significantly when some other organs of the patient suffer, primarily the liver. Those who are able to survive a bleeding episode often experience a relapse after a couple of years if they do not follow all the doctors' recommendations.
Varicose veins of the esophagus appear due to reasons that a person can acquire, or they can be congenital. In the first case, the scale of bleeding can lead to quite sad consequences.
Very often, the cause of bleeding in the esophagus can be fixed objects in it with sharp or cutting corners. A tumor can also trigger this process if it envelops some large venous vessel, causing it to break through, for example, into the descending part of the aorta. But at the same time, varicose veins of the esophagus also occur, and it can never be excluded in cases where bleeding has occurred.
The main cause of blood loss that occurs in the lower esophagus is congestion occurring in the portal vein of the liver. This manifests itself in cirrhosis and thrombosis of the vena portae (Latin name for the portal vein). One of the most common manifestations of bleeding in the upper part is a malignant goiter. But these are not all the reasons leading to blood loss in the esophagus. You should also add to them angioma of the esophagus and vascular changes in Rendu-Osler disease and more common diseases:
The main problem that leads to esophageal varices is cirrhosis of the liver. Patients with this disease very often, sooner or later, encounter complications in the gastrointestinal tract. The root cause of cirrhosis is different things:
At the same time, connective tissue grows in the liver, pathological regeneration of parenchyma and portal hypertension occur. There are also cases of liver cirrhosis in newborns, the causes of which are associated with the mother’s exposure to viral diseases during pregnancy.
The reason that so many diseases affect the occurrence of esophageal varices is due to the connection of these vessels with the vessels of other abdominal organs. If certain changes occur in any of them, the effect spreads to other organs.
Like many other diseases, esophageal varicose veins have their own specific degrees of development, depending on which the doctor selects the optimal treatment for the patient. You can get rid of varicose veins only by seeking help in time.
With grade 1 varicose veins, the disease picture is quite weak and not pronounced. In this case, there may not even be any complaints about anything. Observation and examination of the patient reveals small expansions of up to three millimeters. In this case, the lumen is not filled, and ectasia is only sporadic or absent. Diagnosis can only be made using the endoscopic method.
More pronounced symptoms are observed with grade 2 varicose veins. In this case, the veins become tortuous. They are more clearly visible in the lower parts of the esophagus. They occupy a third of it, while the mucous membrane does not undergo changes. Diagnosis of the second degree can be carried out using the radiographic method.
Often, gastroenterologists diagnose grade 3 varicose veins, since in this case patients themselves seek help, and do not accidentally discover the problem. In rare cases, surgery can be avoided. The dilated veins of the esophagus swell, the nodes are clearly visible. The mucous membrane becomes very thin. The patient experiences GEF reflux.
The last fourth degree of development of varicose veins is the most difficult. Severe damage to the esophagus is accompanied by blood loss. The nodes form clusters that cover the entire esophagus. Its surface is too deformed and changes.
Often, varicose veins of the esophagus appear in people whose age reaches fifty years. It is observed much more often in males. The course of the disease is purely individual, since the causes of its occurrence are different. It can be sluggish and even unnoticeable, or sharp and rapid. The patient sometimes does not pay attention to symptoms that seem insignificant to him. Among them:
This symptomatology implies esophagitis - a companion to varicose veins. If the body begins to lose blood, the patient will experience all the characteristic signs of anemia, including fatigue, pallor, weight loss and shortness of breath.
With varicose veins, it is important to prevent bleeding. If this fails, all possible measures should be taken to stop it. Based on the degree of development of the disease, three possible treatment methods can be determined:
Portal hypertension that has arisen in the vessels must become controlled, that is, the pressure should be made normal so that the vein wall does not break through. Special medications that are often used for various cardiovascular diseases can help with this. Among them, beta blockers, which lower blood pressure, play an important role. In addition to them, you can also use the well-known nitroglycerin. But it works well only with long-term use, and not with a single dose. This, like other methods of lowering pressure, constitutes a hemostatic method of treatment. The doctor chooses the most optimal method of recovery:
Electrocoagulation is the removal of damaged veins using electric current. Bandages in the form of rubber discs are used to stop bleeding. Special probes are also used that compress damaged areas of the veins. If the patient does not tolerate the entire description of the method, alloying of esophageal varices is also used, which consists of ligating the deformed areas with special rings. They do not allow these altered veins to expand.
Doctors also use various surgical methods, among which sclerotherapy is popular. It involves the introduction of a special solution into the vein of the esophagus, which is repeated after 5 days, the first and third months. This procedure is performed several times a year and is performed by a vascular surgeon.
Surgical methods also include some other things such as:
In each specific case, it is necessary to make a decision on the use of a specific method based on the medical history, research results and the patient’s well-being. Treatment of varicose veins of the esophagus should be carried out by a doctor only using the most optimal method.
To prevent esophageal varicose veins from developing, it is important to adhere to small preventive methods that do not completely change your lifestyle. It is important to start it when doctors have diagnosed first-degree esophageal varicose veins. The rules to follow are as follows:
You need to eat 4-6 times a day in small portions. Three hours before bedtime it is better not to eat at all. Food heated to high temperatures is prohibited. It is best to enrich the diet for varicose veins with boiled or steamed foods.