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Varicose veins in the esophagus symptoms

28 Aug 18

Esophageal varices: causes and treatment, possible bleeding

From this article you will learn: what varicose veins of the esophagus are, what reasons can lead to the appearance of this pathology. The clinical picture, diagnosis and treatment of varicose veins of the esophagus are also described.

Esophageal varices (abbreviated as esophageal varices) are a pathological increase in the diameter of the venous vessels located in the lower part of the esophagus. Most often, this pathology is caused by portal hypertension (abbreviated as PH) - an increase in pressure in the portal vein (v. portae), which flows into the liver and collects blood from almost the entire intestine.

Compared to other types of varicose veins, varicose veins have completely different causes, symptoms and treatment. What unites these different pathological conditions is only the presence of enlarged veins.

The presence of varicose veins is only one of the symptoms of severe diseases leading to portal hypertension. Its appearance is most often caused by cirrhosis of the liver - a dangerous and almost irreversible disease. Typically, the treatment provided only slightly alleviates the patient's condition, but cannot completely cure it.

The problem of varicose veins is dealt with by hepatologists, gastroenterologists, and surgeons.

Causes of esophageal varicose veins

The veins of the lower part of the esophagus flow into the v. system. portae. When PG occurs, which is practically the only direct cause of VRVP, the pressure in them increases.

Superior and inferior vena cava system

The veins of the lower part of the esophagus connect with the vessels of the middle third of the esophagus, which flow into the superior vena cava. Since the pressure in v. portae becomes much higher than in the venous vessels of the middle part of the esophagus, blood is discharged from it into the system of the superior vena cava through these junctions (anastomoses). Varicose veins of the esophagus are these enlarged anastomoses.

VVD is not an independent disease. The development of this pathology is caused by diseases that lead to the occurrence of PG. Some of them are listed in the table:

Congenital narrowing of the portal vein

Increased blood flow in the portal vein due to the presence of a fistula

Increased blood flow in the splenic vein

Acute hepatitis (especially alcoholic)

Congenital liver fibrosis

Right-sided heart failure

Only sometimes varicose veins of the esophagus can develop without PG - for example, with thrombosis of the splenic vein.

Characteristic symptoms

By itself, VUV does not cause any symptoms until bleeding develops.

Since this pathology is predominantly one of the complications of portal hypertension, one can suspect their presence if patients have symptoms of liver cirrhosis, which include:

  • Decreased appetite.
  • Nausea and vomiting.
  • Yellowing of the sclera, mucous membranes and skin.
  • Weight loss.
  • Pain or discomfort in the right hypochondrium.
  • Skin itching.
  • Ascites (accumulation of fluid in the abdomen).
  • Increased bleeding.
  • Sexual dysfunction.
  • Symptoms of encephalopathy, which include sleep disturbances, decreased intelligence, memory impairment, and abnormal behavior. These symptoms can be so severe that the patient cannot even take care of himself or lead a socially acceptable lifestyle.
  • Due to hypertension in the inferior vena cava system, in severe cases, ascites and the “head of the jellyfish” symptom (dilation of the veins of the anterior abdominal wall) occur. Indicated by arrows

    Possible complications

    Almost the only complication of VRVP is bleeding, which poses an immediate danger to the patient’s life and impairs his functional abilities. Signs of its occurrence include:

  • Black stools (melena) or blood in the stool.
  • Vomiting blood.
  • Rapid and noisy breathing.
  • Dizziness.
  • Rapid heartbeat (tachycardia).
  • Fall in blood pressure.
  • Pale skin.
  • General weakness.
  • Deterioration of consciousness, agitation.
  • Decreased amount of urine.
  • Although many people with severe liver disease develop esophageal varices, not everyone experiences bleeding. Factors that increase its risk:

  • High pressure in v. portae. The risk of bleeding increases with increasing PG.
  • Large varicose veins. The larger the nodes, the higher the risk of complications.
  • Red spots on varicose veins. During endoscopy, some nodes have red spots. Their presence indicates a high risk of bleeding.
  • Severe liver damage. The more severe the liver disease, the more likely it is to bleed from the urinary tract.
  • Continued alcohol abuse. The risk of complications increases if the patient continues to drink alcohol, especially if the disease is caused by it.
  • If a person has cirrhosis of the liver, their doctor should regularly test them for the presence of varicose veins. Basic examinations to identify this pathology:

  • Esophagogastroduodenoscopy (EFGDS) is the most common way to diagnose esophageal varicose veins. During this endoscopic examination of the upper digestive tract, the doctor inserts a thin, flexible, lighted tube (endoscope) through the patient's mouth and examines the structure of the esophagus, stomach and duodenum. If the doctor does not detect esophageal varices in a patient with cirrhosis, he usually recommends repeat EGD after three years. If varicose veins are detected, endoscopy should be performed every 1 or 2 years. The time for re-examination depends on the appearance of the varicose veins, the cause of the varicose veins and the general health of the patient. Also, during EGD, endoscopic treatment of bleeding from the varicose veins can be performed.
  • Capsule endoscopy - During this test, the patient swallows a small capsule containing a tiny video camera that takes images of the esophagus and the rest of the gastrointestinal tract. These images are then reviewed by a doctor to determine if there is any pathology. This method may be an alternative for those people who cannot undergo EGD, but it is used very rarely due to its high cost and inaccessibility.
  • Imaging examinations. Computed tomography of the abdomen and Doppler ultrasound of the portal and splenic veins can confirm the presence of varicose veins.
  • Almost every patient with varicose veins undergoes the following laboratory examination:

  • Determination of the level of hemoglobin, red blood cells, platelets and leukocytes.
  • Coagulogram (test for blood clotting).
  • Biochemical analysis, including tests for the condition of the kidneys (urea, creatinine) and liver (aminotransferases).
  • Blood type.
  • X-ray of the chest cavity.
  • Analysis of ascitic fluid.
  • Depending on the suspected cause of PG, other examination methods may be needed.

    The main goal in treating varicose veins is to prevent bleeding, which can be life-threatening. If bleeding occurs, all efforts are aimed at stopping it.

    Prevention of bleeding

    Treatment aimed at reducing pressure in v. portae may reduce the risk of bleeding from varicose veins. It may include the following methods:

    1. Refusal of drinking alcoholic beverages. This is one of the most important methods for preventing bleeding from varicose veins. Alcohol can worsen cirrhosis, increase the likelihood of bleeding, and significantly increase the risk of death.
    2. Weight loss. Many people with cirrhosis have fatty liver due to obesity. Obesity can be both an independent cause of liver damage and a contributing factor in its development. Losing weight can help remove fat from the liver and reduce further damage.
    3. The use of drugs to reduce pressure in v. portae. Reduce pressure in v. portae and beta blockers (propranolol, nadolol) can reduce the likelihood of bleeding.
    4. Bandaging of VRVP with elastic rings. If the doctor sees on EGD that there is a high risk of bleeding from the varicose veins, he may recommend endoscopic ligation (ligation). Using an endoscope, the doctor places an elastic ring on the varicose node in the esophagus, which compresses the vein and prevents it from bleeding. This minimally invasive surgery has a small risk of complications, such as scarring of the esophagus.
    5. Stopping bleeding from VRVP

      Bleeding from esophageal varices is a life-threatening condition that requires immediate medical attention. Methods used to stop bleeding and eliminate the effects of blood loss:

    6. Ligation of bleeding esophageal varices using elastic rings.
    7. Tamponade using a Blackmore probe. This method is used as a temporary rescue measure for uncontrolled bleeding from the esophageal urinary tract. The Blackmore probe has two balloons. It is inserted into the stomach through the mouth, after which the doctor inflates the first (gastric) balloon. The probe is then gently pulled up until the inflated balloon rests against the gastroesophageal junction. Doctors inflate the second balloon (esophageal). The inflated balloons of the Blackmore probe press against esophageal varices, thereby stopping bleeding.
    8. Medicines that slow blood flow in the portal vein. To reduce the flow of blood from internal organs into the portal vein system, doctors often prescribe the drug Octreotide. Drug therapy complements endoscopic vascular ligation and lasts approximately 5 days.
    9. Redirection of blood flow from the v. system. portae. Doctors may recommend that a patient with varicose veins undergo a transjugular intrahepatic portosystemic shunt, which involves placing a small tube (shunt) connecting the v. portae and hepatic vein. This shunt reduces the pressure in v. portae and helps stop bleeding. However, such surgery can cause serious complications, including liver failure and brain problems, which can occur because toxins normally cleared by the liver enter the systemic bloodstream directly through the shunt. This method is most often used when other methods of reducing pressure in v are ineffective. portae, and also as a temporary measure in people awaiting liver transplantation.
    10. Restoration of circulating blood volume. To replace lost blood and eliminate clotting factors, patients are often given transfusions of blood components.
    11. Prevention of infections. As bleeding develops, the risk of infectious complications increases, so patients are often prescribed antibiotics.
    12. Liver transplantation is a treatment option for patients with severe liver damage who develop recurrent bleeding episodes.
    13. Blackmore probe

      Esophageal varices are a dangerous complication of PG, most often caused by cirrhosis of the liver. The main danger to the lives of patients is bleeding, the first episode of which leads to death in 30–50% of patients. After the first episode of bleeding, 60–80% of patients experience repeated episodes within a year, of which about 30% of patients die.

      The risk of early recurrent bleeding (within 5 days from the first episode) is also influenced by the severity of liver damage:

      Causes and symptoms of esophageal varicose veins

      Savin Evgeniy Valerievich – Phlebologist

      Chernyakov Vadim Petrovich – Phlebologist

      Shershen Oleg Olegovich – Vascular surgeon

      Danilov Roman Ilyich – Phlebologist

      Varicose veins of the esophagus, causes of development, symptoms of the disease, proper treatment and prevention. What is the right diet, reviews from doctors and users. Classification of the disease, what you need to know first.

      Esophageal varicose veins - what is it?

      In order to understand this problem more clearly, it is necessary to better understand the essence of the blood supply process in the esophagus in general and, in particular, what are the root causes that provoke the growth of veins.

      A large number of vessels organize blood supply to the esophagus. Its immediate upper lobe is filled with blood fluid due to the work of the main vessels. The arterial branches of the bronchi and thoracic aorta take part in the blood supply to the upper lobe.

      The interweaving of veins themselves have a rather complex and complex structure. Venous blood flows in two directions: ascending and descending, respectively. The entire set that connects the venous channels together is called by doctors the portocaval anastomosis system.

      Varicose veins are the most common and common in this area . The disease of esophageal varicose veins is expressed in two manifestations:

      Additionally, doctors consider acquired and congenital diseases. The first type is typical for people who have reached the age of 50. It is quite remarkable that men are more susceptible to this form than women. The ratio of sick men to sick women is expressed in the proportion 2:1.

      The second type, or congenital form, is described in the literature by doctors, but in practice it is quite rare. As a rule, babies with this disease also suffer from many other ailments.

      Among the reasons that lead to this disease, doctors identify several main ones:

    14. Liver diseases that interfere with blood flow in the human body.
    15. Cardiovascular failure.
    16. Blood clots.
    17. Portal vein tension caused by tumors.
    18. All of the above reasons must be treated promptly and correctly.

      In order to begin treatment of the disease in time, you need to know its most striking signs and be able to recognize them. In the early stages, it will be difficult to do on your own, since this disease is characterized by the absence of symptoms until a specific period, or its symptoms are similar to other diseases.

      Initial symptoms may include:

    19. Dyspnea.
    20. Painful sensations.
    21. Heaviness behind the chest.
    22. Heartburn.
    23. Problems with the swallowing process.
    24. The presence of the specifically listed phenomena is not constant at all. At more serious stages of the disease, the so-called head of the jellyfish becomes a striking manifestation. This is an enhanced pattern of blood vessels in the chest area.

      Also, intense blood flow from unhealthy venous channels is already a concrete and accurate symptom. At this stage, rapid heartbeat, blood in the sputum, irregular, watery, dark-colored stools, and vomiting (a mass similar in consistency to coffee grounds or blood) appear.

      In a situation with excessive loss of blood fluid, the patient faces a serious threat to life. If blood loss is not abundant, anemia quickly begins to form, causing impotence, low blood pressure, weight loss, rapid heartbeat and shortness of breath.

      Such a disease must be treated; healing is characterized by preventive methods. The goal of doctors is to avoid blood loss. Much happens due to the actions of the patient himself. It is necessary to reconsider the daily regimen, since the disease is dangerous.

      A ban on serious physical activity is introduced; it is important to maintain a routine and eat according to a diet.

      Bleeding with varicose veins of the esophagus develops as a result of cirrhosis of the liver. A phenomenon that threatens the patient's life. It is often the cause of death in such patients. There can be many causes of liver cirrhosis, among them: long-term intoxication and thrombosis of liver vessels.

      Due to the high load, the venous system does not have time to cope with the main tasks and the formation of varicose venous channels (VVCs) occurs. With varicose veins, the development of blood loss occurs in 30% of all diseases.

      The percentage of deaths during the first bleeding from enlarged veins is characterized by a range from 30 to 50%; in the case of repeated blood loss, the percentage increases, falling within the range of 50-90%.

      Blood loss is possible both from the esophagus (often repeated) and from the gastric veins. The root cause is a flaw in the wall of the varicose vein itself, most often of a jet nature. The manifestation of varicose bleeding is a gag reflex and the release of vomit containing blood.

      There are other signs of bleeding: dizziness, rapid drop in blood pressure, sweating and weakness. The manifestation of clinical signs of bleeding is directly related to the intensity of blood secretion: the stronger the first, the sooner the second appears.

      Diagnosing bleeding when liver cirrhosis is diagnosed is quite simple. It is the search for the root cause and stopping the bleeding itself that requires first-class action from the medical team, since it is necessary to take prompt and correct actions and work harmoniously.

      A significant role in the situation will be played by the correctly chosen formulation of tasks, qualified personnel: endoscopist, surgeon, anesthesiologist, resuscitator, gastroenterologist-hepatologist.

      It is possible to stop the release of blood in the esophagus when it occurs in several ways. Doctors divide techniques for achieving hemostasis with blood flow from veins into four types:

      • surgical;
      • pharmacological;
      • balloon tamponade;
      • endoscopic.
      • With prolonged strong blood flow, endoscopic arrest is unlikely. There is a high risk of death, so actions must be taken within a period of no longer than five minutes. Afterwards, the main role and control of the process passes to the surgeon.

        Using an obturator probe, the doctor must achieve temporary hemostasis. At the same time, the blood volume in the patient’s body is replenished. It is important at this stage that resuscitators compensate and stabilize the process of functioning of the organs and systems of the body.

        Laser sclerosis of veins

        The whole problem of the situation is that such patients soon develop liver failure and decompensation. If everything goes well, when a stable condition is established and blood flow is stopped, doctors perform endoscopic hemostasis using alloying or sclerosis of varicose veins.

        Ligation involves pressing down the varicose vein, after which a rubber holder is placed on its base. Thus, the blood flow is interrupted. This operation occurs using a ligator, a device that is carried out through an endoscope.

        Vein sclerosis is performed differently. When using an endoscopic injector with a retractable 4 mm needle, the doctor injects a sclerosing agent close to the vein. After 4-5 days from the moment the bleeding stops, the first screening examination of the patient is scheduled. In the future, constant monitoring by a gastroenterologist-hepatologist is mandatory.

        Balloon tamponade method

        The treatment of bleeding with balloon tamponade for esophageal varices has been widely described. The Blakemore probe is known and most actively used by doctors. If it is placed correctly, bleeding can be successfully stopped in 60-90% of treatments.

        However, the danger is that after removing the probe, bleeding may resume again. The maximum allowable probe dwell time is 24 hours, no longer allowed.

        Surgical treatment

      • Transjugular intrahepatic portosystemic shunt (TIP S).
      • Bypass surgery.
      • Devascularizing surgical operations.
      • TIP S is a medical intervention during which an unnatural intrahepatic cavity of some kind is created, into which a metal self-expanding stent is inserted. This method is capable of restoring blood flow in almost all situations and is performed under local anesthesia.

        However, with all the advantages, there is also a negative point: the occurrence of hepatic encephalopathy is almost inevitable.

        Shunt surgery is just as effective as TIP S, but is more traumatic. It should be noted that in this case the formation of encephalopathy is possible.

        This type of surgery can effectively stop blood flow, but the root cause of portal hypertension is not eliminated. Subsequently, this leads to a rapid, unwanted recurrence of varicose veins.

        Propranolol helps well in preventing the first bleeding for varicose veins of the esophagus; it is prescribed by a doctor. Additionally, venotonics are used. Drugs that normalize the smooth muscles of the walls of blood vessels, improve elasticity and increase resistance to blood flow.

        When identifying esophageal varicose veins, the following factors play a significant role:

      • complaints and symptoms of the person visiting the doctor;
      • instrumental methods (EGD), ultrasound examination (US) of organs in the abdominal cavity, X-ray examination;
      • objective assessment of the patient’s condition: skin, pallor, yellow skin, swelling of the body and limbs. The presence of spider veins or hemorrhages on the skin, changes in the size of the abdomen, spleen and liver, varicose veins on the anterior abdominal wall;
      • laboratory tests, general and biochemical blood tests, determination of blood clotting, determination of the Rh factor, as well as performing a cross-compatibility test for 6 doses of er-mass;
      • analysis of the disease and the patient’s standard of living, how long the symptoms have been bothering them, how the disease progresses, what diseases have been suffered previously (tumors, hepatitis, cirrhosis).
      • It is possible to identify varicose veins of the esophagus and stomach even during an initial examination by a doctor, who, in turn, will conduct research and prescribe the necessary additional tests.

        When formulating a diagnosis, the disease that was the root cause is initially indicated, and then the rest. At the end of the examination of the patient, it is necessary to indicate complications, if any.

        Treatment of esophageal disease

        It is impossible to recover from the disease. The goal of treatment in a specific situation is to prevent bleeding. Doctors have developed several main positions for curing varicose veins, here are the main ones:

      • Patient's lifestyle. We exclude heavy power loads, monitor hygiene, and get more rest.
      • Identify the source of the disease that caused the development of varicose veins (cirrhosis, hepatitis).
      • Food intake system (diet as prescribed by a doctor).
      • Treatment with medications.
      • Astringents.
      • Vitamins.
      • Medicines that reduce the level of acidity in the stomach.
      • Transfusion of blood, plasma, crystalloid and colloid solutions, packed red blood cells in the case of blood flow. Prescribing hemostatic drugs, prescribing a probe, applying thrombin or a special film with an adhesive layer to the affected area.
      • Surgical intervention, including radical and palliative methods.
      • Cardinal - anastomosis (portocaval and splenorenal). Removal or preservation of the spleen depends on the situation, the decision is made by a group of operating doctors.
      • Palliative - clamping of the splenic artery, the process of crossing the azygos and portal veins, removing vessels, as well as the affected part of the esophagus.

    Varicose veins cannot be treated, but if diagnosed in time and given the correct treatment, the patient’s condition can be maintained.

    If the blood flow opens, you should immediately contact an ambulance. In order to provide the necessary procedures by specialists, it is necessary to constantly consult with a gastroenterologist and hepatologist.

    It is classified based on symptoms and changes in the body into 4 types.

    In this case, single venous ectasia becomes noticeable. Their presence is detected during examination with an endoscope. The veins have a girth of 5 mm, their elongation is visible, and are located in the lower floor of the organ.

    The veins are tortuous, already 10 mm in diameter, located in the middle floor of the organ.

    This type is characterized by a particularly noticeable separation of the venous channels, which pass in the lower floor of the esophagus. During this period, the lumen is not yet distinguished by narrowing, and no changes are noticeable on the mucous membrane.

    The venous channels are tense, the walls are thin, their girth is already more than 10 mm, and they are located directly next to each other.

    This type is characterized by swelling of the veins, which are located above the center of the esophagus. The lumen of these veins is already narrowed. Single angioectasias are noticeable - red icons.

    When varicose formations in the lumen, thinness of the mucous membrane, and then erosion and angioectasia on the mucous membrane become noticeable, the typology is grade 4.

    With a disease such as varicose veins of the esophagus, diet becomes one central measure that helps maintain the patient’s health and preserve the digestive system. In this case, it is important to remember that proper nutrition is 4-6 meals a day (in one day).

    The last meal should be taken 3-4 hours before bedtime. It is better to steam or cook products. Doctors recommend eating food at the optimal temperature, not excessively hot or cold.

    It is important to take care of your health; you should not allow acidic liquid from the stomach to enter it. To prevent this from happening, you need to raise the head of the patient's bed by at least 10 cm.

    You cannot be distracted while eating; we are talking about talking, watching TV, working on the computer or reading. A person simply swallows air, is distracted by what is happening, worries, is surprised, rejoices, all this makes it difficult to eat and assimilate food.

    By eating properly, you can help your body. Remove excess fluid, thereby improving the elasticity of the venous channels and making the vascular walls stronger.

    If the diet is supplemented with a constant, daily set of light exercises, it is possible to activate blood flow and reduce the possibility of problems with blood vessels (formation of blood clots, accumulation of fats).

    For this disease, doctors recommend supplementing your diet with additional substances that have a positive effect on the body:

  • vitamin E (green onions, wheat grain, egg yolk, olive and corn oil);
  • vitamin C (currants, citruses, strawberries, potatoes, gooseberries, parsley, dill);
  • boiflavonoids (cherry, cherry);
  • rutin (walnut, grapefruit, tea, lemon);
  • substances that stimulate elastin synthesis (mussels, squid, oysters, lobsters, shrimp);
  • vegetable fiber (fruits, vegetables, bran).
  • It is important to consume the required amount of liquid, on average up to 2 liters per day, half of which is water.

    It is important to know what foods you should avoid in order to maintain health and extend your life.

    These ingredients include the following:

  • Black strong tea.
  • Baked goods made from first and higher grinding flour.
  • Alcohol.
  • Confectionery.
  • Additives and aromatic herbs.
  • Sugar product.
  • Caffeine, coffee, coffee drinks.
  • Nutritionists have developed a colored diet specifically for people with varicose veins problems. The principle of eating foods of the five main ranges:

  • orange – pumpkin, citruses;
  • red – berries, apples, tomatoes;
  • blue – blue;
  • green – cucumbers, green onions, peas, sweet peppers;
  • yellow – apples, lemons, bananas.
  • It is not recommended to consume dairy products and excessive amounts of salty foods. Replace meat with seafood. The diet can be supplemented with therapeutic fasting. The principle of this type of fasting is fasting days (1 day a couple of times a week).

    To keep the body in shape and prevent healthy veins from turning into varicose veins, it is necessary to primarily monitor the condition of the liver, without delay, and to correctly treat emerging diseases. It is necessary to periodically visit doctors, receive consultations and follow the doctor’s recommendations.

    Preventive measures include attention to the quality of your own life, and this means following a diet, leading a correct and healthy lifestyle, and following regimens. It is important to avoid heavy physical activity; you can take choleretic herbs to make the functionality of the intestines more effective. The release of bile will speed up important processes in the body.

    It is important to always remember that our health is directly related to many factors, but we ourselves and our lifestyle are paramount.

    In order to prevent the occurrence of various kinds of diseases, and especially such serious ones as esophageal varicose veins, you need to take care of yourself: eat right, lead a healthy lifestyle, go to the doctor in a timely manner, get examined, follow the recommendations. If necessary, undergo treatment courses.

    This is a disease with a high mortality rate due to complications. The prognosis of the disease seems to be as follows: when bleeding stops in 79%, death from varicose veins accounts for 50% of all patients. The possibility of recurrence in the next few years, even for those who have experienced an attack of varicose veins once, ranges from 55 to 75%.

    It is possible to reduce the risk by following all the instructions of the attending physician. This procedure does not guarantee long life as liver disease progresses. Often, varicose veins occur, usually with cirrhosis of the liver.

    The main thing is not to allow aggravating circumstances and if the simplest and most minor symptoms occur, be sure to consult a specialized physician.

    Esophageal varicose veins: what is it and how to treat it?

    Varicose veins of the esophageal veins appear due to a violation of the blood flow that comes from the veins along the ducts of the collar and superior vena cava. It has been observed that the disease more often affects people over 50 years of age. Women get sick 2 times less often than men.

    Varicose veins occur against the background of liver diseases, especially cirrhosis. The disease of varicose veins of the esophagus is accompanied by bleeding, both small and heavy.

    Classification of the disease

    The classification of the disease of varicose veins of the esophagus has changed several times, however, the version from 1997 for the veins of the esophagus is now used, dividing the disease into degrees:

  • First degree. The veins reach 5 mm in diameter, are noticeably elongated, and are located at the lower level of the organ.
  • Second. The veins are convoluted, reach 10 mm in diameter, and are located in the middle part of the organ.
  • Third. Veins are characterized by tension and thinness of the walls, reach more than 10 mm in diameter, and are located next to each other. “Red markers” often form on their surface.
  • Diagram of gastric varices

    For varicose veins not just of the esophagus, but of the stomach, other similar classifications are used:

  • Grade 1 varicose veins of the esophagus. Veins are less than 5 mm in diameter and are poorly distinguishable against the background of the gastric mucosa.
  • Grade 2 varicose veins of the esophagus. The veins reach 10 mm in diameter and are solitary-polypoid in nature.
  • Grade 3 varicose veins of the esophagus. Veins are larger than 10 mm, form a “mixture” of nodes, and are polypoid in nature.
  • According to Vitenas and Tamulevichiute

    There is also a classification according to Vitenas and Tamulevichiute, which distinguishes 4 degrees of the disease, although not related to the gastric veins:

  • veins are 2-3 mm in diameter, bluish, and linearly directed;
  • veins form nodules exceeding 3 mm, are uneven, and tortuous;
  • the veins form distinct nodes, convolute, protrude into the lumen of the esophagus and reach the gastric vault;
  • vein nodes have a grape-shaped and polypoid shape, close or significantly narrow the lumen of the esophagus; The mucous membrane covering the node is often covered with a thin network of small veins, that is, varicose veins are formed on varicose veins.
  • The Scientific Center for Chemistry of the Russian Academy of Medical Sciences also offers its classification. She distinguishes 3 degrees of the disease:

    Zdenek Maržatka also distinguishes 3 degrees, but more advanced:

  • 1 - longitudinal veins, slightly elevated above the mucous membrane;
  • 2 - expand and wriggle;
  • 3 - protrude up to half the lumen, pseudotumor appearance;
  • Regardless of the degree, varicose veins are considered an incurable disease. However, this is not a reason to ignore the disease, since its delay or improper treatment leads to the death of the patient.

    Next we will talk about the causes of esophageal varicose veins.

    For clarity, we recommend watching the following video about grade 3 varicose veins of the esophagus:

    Causes

    Varicose veins can be congenital or acquired. The second occurs several times more often and occurs due to portal hypertension. Portal hypertension is a disease characterized by increased pressure in the portal vein, which is responsible for the flow of blood from organs to the liver, leading to thinning of the vein walls and an increased risk of internal bleeding. Portal hypertension develops due to blockage of blood flow.

    Factors leading to the appearance of varicose veins include:

  • liver diseases, for example, cirrhosis, hepatitis, tuberculosis and others;
  • thrombosis of the vascular system;
  • persistently elevated blood pressure;
  • compression of the portal vein;
  • Read on to find out what symptoms varicose veins of the esophagus have.

    Symptoms of varicose veins of the esophagus

    The disease develops individually, its course depends on accompanying factors. So, in some it may be asymptomatic. In some cases, the disease has a rapid course, although the symptoms remain general and manifest themselves in:

    1. heartburn;
    2. difficulty swallowing food;
    3. discomfort in the chest area;
    4. rapid heartbeat;
    5. blood impurities in stool;
    6. Also, with varicose veins of the esophagus, other symptoms may appear, for example, pain, a general feeling of fatigue and others.

      A specialist will talk about the symptoms and causes of esophageal varicose veins in the following video:

      Diagnosis of varicose veins of the esophagus is impossible without hardware examination, since the disease has no characteristic symptoms. When visiting a doctor, the patient is prescribed:

    7. General and clinical blood tests to assess the patient's condition.
    8. Functional and liver tests to evaluate coagulopathy.
    9. Abdominal ultrasound and x-ray to confirm the diagnosis.
    10. Fibroesophagoscopy to determine the causes of bleeding.
    11. Depending on concomitant diseases, additional studies may be prescribed.

      Treatment of esophageal varicose veins is complex, combining, at a minimum, therapeutic and medicinal techniques. In the later stages of esophageal varicose veins, the patient is indicated for surgical treatment.

      Therapeutic treatment of varicose veins of the esophagus is prescribed in combination with medication for stage 1 of the disease or with surgery in the later stages. Therapy consists of strict adherence to nutrition and diet, limiting physical activity, and giving up bad habits.

      The most common operation for varicose veins of the esophagus is sclerosis. During the operation, a prepared solution is injected into the affected veins, into the lumen. The procedure is repeated after 5 days, then 1 month and 3 months. To achieve a sustainable effect, it is necessary to repeat the procedure at least 4 times every 12 months.

      The following operations are also performed for varicose veins:

    12. Portosystemic stent shunting. A stent is inserted into the liver to connect the portal and hepatic veins.
    13. Anastomosis.
    14. Vein lining.
    15. Devascularization. In this case, the affected veins are completely removed and replaced with a prosthesis.
    16. The type of surgical intervention depends on the patient's wishes and the degree of the disease.

      We will tell you further about what medications are prescribed for varicose veins of the esophagus.

      Drug treatment is aimed at reducing the negative impact on the venous walls. For this, the patient is prescribed:

    17. agents that reduce stomach acidity;
    18. astringents;
    19. As well as synthetic vitamin complexes.

      The diet for varicose veins of the esophagus is in many ways similar to the principles of proper nutrition. The patient should eat in small portions 4-6 times a day, with the last meal taken 3 hours before bedtime. Particular attention should be paid to products containing:

    20. Vit. E. Green onions, yolk, lettuce, corn and vegetable oils.
    21. Vit. C. Citrus fruits, berries, potatoes, bell peppers, herbs.
    22. Bioflavonoids. Cherry, sweet cherry.
    23. Rutin. Nuts, grapefruits, tea, black currants.
    24. Plant fiber. Vegetables, fruits and legumes.
    25. It is important to drink enough liquid, from 1 liter of clean water per day.

      A patient suffering from varicose veins should avoid the following products:

    26. alcohol;
    27. strong black tea;
    28. confectionery and sugar;
    29. hot spices;
    30. products containing flour;
    31. coffee;
    32. Disease prevention

      Prevention of varicose veins is aimed at maintaining the normal condition of the veins. First of all, it is necessary to carefully monitor the condition of the liver and follow all recommendations for the treatment of diseases. If a patient experiences a persistent increase in blood pressure, it is recommended to take measures to regulate it.

      General preventive recommendations relate to maintaining a healthy lifestyle. It is necessary to strictly follow the diet and give up bad habits. It is also worth performing light exercises to strengthen the body, periodically attending a massage, and also taking vitamins according to the course.

      The most serious complication is bleeding. In this case, bleeding can occur even from small efforts such as overeating, since the walls of the veins become very thin. Bleeding may be small or severe and may be life-threatening. Bleeding leads to vomiting and chronic anemia.

      Varicose veins can also be accompanied by esophagitis, an inflammatory process of the esophageal mucosa.

      Esophageal varices have a high mortality rate, mainly due to complications and concomitant diseases, such as progressive cirrhosis, causing bleeding. Despite the fact that bleeding stops on its own in approximately 79% of cases, the mortality rate from varicose veins reaches 50%. For patients who bleed and survive, the risk of recurrence in the next two years ranges from 55-75%.

      You can reduce the risk of recurrent bleeding by following your doctor's instructions. However, this does not guarantee long-term survival due to advanced liver disease. Note that varicose veins of the esophagus often occur with cirrhosis of the liver.

      It is important to remember, in order to prevent complications, at the first sign of any type of varicose veins (legs, uterus, pelvis, labia, varicocele, etc.), you should immediately consult a doctor. Be healthy!

      Varicose veins of the esophagus

      Esophageal varicose veins occur when the outflow of blood from the veins of the organ is disrupted. Because of this, they begin to change: they lengthen, expand and twist, forming nodes, which are called varicose veins. This condition occurs quite often and has its own reasons.

      Causes of varicose veins

      Typically, varicose veins of the esophagus occur against the background of portal hypertension, which, in turn, develops due to the fact that the blood flow encounters obstacles. The portal vein should normally have a pressure of about six mm. Hg If this figure is exceeded and ranges from 12 to 20, then expansion of the portal vein anastomoses occurs, where there is an increase in blood outflow, leading to varicose veins. In addition, there are certain diseases that contribute to the development of pathology:

    33. polycystic liver disease;
    34. cirrhosis of the liver;
    35. congenital liver fibrosis;
    36. liver tumors;
    37. aneurysms of arteries, hepatic or splenic;
    38. sarcoidosis and so on.
    39. The veins of the esophagus have a close relationship with the collar zone, with its venous system and with the veins of the spleen. If any disease of the abdominal cavity appears, the risk of blockage of the venous networks increases, this situation provokes the development of varicose veins. This disease manifests itself at any age, but most often it occurs in those who already have cirrhosis in their medical history - a pathology in which the structure of an organ is disrupted, tissues begin to grow, this leads to the cessation of some functions.

      Symptoms of the disease

      The initial stage of the disease does not have any special symptoms, although heartburn sometimes occurs. Few people pay attention to such a symptom and immediately go to the doctor for examination, and this symptom often accompanies other problems in the body. Therefore, varicose veins enter an advanced stage, accompanied by the following symptoms:

      The problem can be detected using x-ray examination. More accurate data is obtained by esophagoscopy, but it must be done very carefully, since injury to the vein can lead to bleeding.

      Often varicose veins of the esophagus and stomach are combined with each other. If there is a separate lesion of the veins, then it is not always possible to speak with confidence about portal hypertension. There is a risk of splenic vein thrombosis. In such cases, a diagnosis called “eosinophilic gastritis” is made. It rarely happens that the cause of the disease is eosinophilic gastroenteritis, but if this does happen, the intestinal mucosa is affected, which becomes the background for the destruction of the muscle layers. It all starts with fibrosis and intestinal obstruction. A histological examination should be performed.

      It is very dangerous when internal bleeding occurs, which can lead to shock and death. In this case, urgent medical care is needed, the first goal of which is to relieve the problem. After this, treatment continues. The pressure in the veins needs to be reduced using various procedures. There are several methods of treating esophageal varicose veins.

    40. Sclerotherapy. It is used to improve blood clotting. Special solutions are injected into varicose veins. The patient may be advised to use a bandage - these are rubber discs installed on dilated vessels.
    41. Intrahepatic shunting. The essence of this procedure is that a stent is inserted into the middle part of the organ. It connects the hepatic and portal veins. The procedure is performed by a doctor who monitors the stent's movement using x-rays.
    42. Splenorenal shunt. Thanks to this procedure, the splenic vein is connected to the vein of the left kidney, the pressure in the varicose vessels is reduced, and this helps prevent bleeding.
    43. It is very important to limit physical activity and follow a special diet. If the disease is at the last stage, there is nothing left but to remove the bleeding veins. In fact, complications can be serious if it is not treated promptly.

      Possible consequences

      With varicose veins, a complication such as esophageal-gastric bleeding sometimes occurs, which can recur and lead to acute liver failure. If a person has cirrhosis of the liver, the problem is complicated by ascites.

      It is worth noting that bleeding originating from varicose veins is the most profuse of all other types, occurring in parts of the gastrointestinal tract. Therefore, every effort must be made to prevent the disease and its complications.

      Bleeding in the esophagus

      Preventive measures for varicose veins include treating liver disease in the early stages. To do this, you need to regularly visit your doctor and follow his recommendations. For example, high portal pressure is reduced by certain medications intended for the heart and blood vessels. for example, beta blockers.

      It is best to consume boiled foods that are steamed. You should not eat very hot or cold food. It is necessary to ensure that the acidic environment of the stomach does not enter the esophagus. To do this, the head of the bed is raised ten centimeters. While eating, you should not watch TV or read; food should be well absorbed by the body.

      Lifting heavy objects should be avoided; it is better to roll the item rather than lift it. In order for the intestines to function effectively, you can take choleretic herbs. They will help speed up the secretion of bile and enhance metabolic processes.

      Of course, the most effective way is to avoid liver problems altogether, and to do this you need to constantly monitor your diet and lifestyle. It’s better to limit yourself to something now than to suffer later.

      Varicose veins of the esophagus - classification and degrees of the disease, treatment methods

      The diagnosis of varicose veins of the esophagus in many cases is made only after bleeding has been recorded, which can occur completely unexpectedly for the patient.

      Most often, pathological dilation of the veins (phlebectasia) in the esophagus occurs as a secondary complication of other diseases; the disease is more typical for people in adulthood, but young people with this pathology are also identified.

      Varicose veins are characterized by pathological expansion of all layers of the vessel , as a result of which its wall protrudes. Thinning and stretching of the veins affects their lengthening and the formation of nodes.

      The modified wall is subject to constant irritation and inflammatory reactions.

      Disturbances in the outflow of the vena cava, which occur due to a number of diseases of the internal organs, predispose to the appearance of saccular formations.

      The onset of the disease does not manifest itself with any symptoms, further increased fragility of the veins leads to their rupture and bleeding, the volume of circulating blood released can be so high that it threatens the patient’s life.

      Causes of dilated veins of the esophagus

      The cause of varicose veins of the esophagus is considered to be a multiple increase in pressure in the cavity of the portal vein ; in medicine, this condition is called portal hypertension.

      can lead to high blood pressure :

      • structural changes in the tissues and blood vessels of the liver - hepatitis, tuberculosis, cirrhosis, neoplasms, amyloidosis;
      • vein sclerosis;
      • blood clot formation;
      • compression of the vein by a tumor, cyst, gallstones;
      • chronic diseases of the cardiovascular system.
      • Varicose veins of the esophagus most often occur in the following categories of patients:

      • in men;
      • in people over 50 years of age;
      • in patients with a history of diseases of the pancreas, stomach, heart, chronic cirrhosis.
      • The appearance of bleeding is affected not so much by the level of pressure as by its sharp fluctuations. ABOUT

        The risk of rupture is also high in those patients who suffer from vascular diseases that negatively affect the structure of the walls of blood vessels.

        Signs and symptoms of the disease

        Pathological expansion of veins can be sluggish or rapid .

        The first symptoms that characterize rapid varicose veins of the esophagus are most often the leakage of blood from the esophagus, its volume depends on the diameter of the vessel and the size of the rupture, sometimes the amount of blood is insignificant, but appears from time to time.

        If a person does not seek help in time, he will develop yellowness of the skin, anemia, weakness, that is, all signs of chronic blood loss.

        With slowly increasing pathological dilation of the vessel, attention is focused on the following symptoms:

      • belching;
      • slight discomfort when swallowing solid food;
      • a squeezing feeling behind the sternum;
      • periodic occurrence of tachycardia.
      • The listed signs correspond to esophagitis - inflammation of the mucous layer of the esophagus, which occurs as a response to irritation from dilated nodules.

        The complexity of diagnosis and treatment, which is known for varicose veins of the uterus, places increased obligations on the patient and the doctor when the disease is suspected.

        Doctors and patients recommend treating varicose veins with horse chestnut when traditional methods of therapy are insufficiently effective.

        With periodic bleeding, melena may occur, that is, the release of dark feces during defecation.

        Before profuse bleeding, the patient may develop a strong feeling of heaviness in the chest and general weakness for several days.

        Blood is released from the oral cavity, its color ranges from scarlet to the color of coffee grounds, while the patient experiences dizziness, weakness, sticky sweat, pale skin, and a drop in blood pressure.

        Classification of varicose veins of the esophagus according to clinical and morphological characteristics divides the disease into four degrees:

      • The first degree of the disease is detected accidentally during endoscopy. An increase in the lumen in one of the parts of the vessel by no more than 3 ml is recorded. The patient is not worried about anything, only complaints about primary diseases are possible.
      • The second degree is characterized by tortuosity of the veins, their unevenness, and no narrowing of the lumen. During the examination, it is possible to identify protrusions or stretched sections of veins. There are no specific symptoms of the disease; some patients at this stage of the disease complain of discomfort when swallowing.
      • In the third degree, the lumen of the esophagus narrows due to the bulging of individual sections of the veins. The mucous layer is changed and more closely resembles the folds of the stomach. Patients complain of gastroesophageal reflux - heartburn, belching, pressure in the upper abdominal cavity.
      • The fourth degree of the disease is diagnosed when numerous vein nodules are detected in the esophagus, not collapsing and with a thinned surface. Numerous erosions are found on the mucous layer. Patients register, in addition to signs of esophagitis, a salty taste in the mouth. The fourth degree most often leads to spontaneous bleeding.
      • The diagnosis is made on the basis of complaints, external examination, and identification of primary diseases. Instrumental studies include:

      • laboratory data from blood tests;
      • X-ray with contrast agent;
      • esophagoscopy, which must be performed carefully due to the risk of possible bleeding.
      • Photo of a patient with perigastric esophageal varices

        Esophageal bleeding, even in the presence of phlebectasia, can be caused by a mucosal ulcer, disintegrating tumor, or Mallory-Weiss syndrome.

        When making a diagnosis, all possible causes must be taken into account and excluded, only then will it be possible to finally and accurately determine the root cause of bleeding and changes in the veins of the esophagus.

        How is the disease treated?

        Treatment for esophageal varices depends on when the disease is detected. If the diagnosis is made during bleeding, then all measures must be taken to stop it.

        Only then is therapy prescribed to reduce the risk of vessel rupture in the future. Varicose veins are treated comprehensively:

      • The initial disease is identified and medications are prescribed based on its severity.
      • The patient is recommended to change his lifestyle , that is, physical activity and bad habits are excluded.
      • A special diet is prescribed aimed at treating the underlying disease. Compliance with the diet is mandatory, since the load on the liver, stomach, and pancreas leads to portal hypertension. The patient must also avoid overeating.
      • In case of bleeding, hemostatic drugs in droppers and injections. Symptomatic therapy is selected depending on the severity of the shock condition.
      • Bandage is a surgical intervention aimed at eliminating varicose veins and stopping bleeding. During surgery, small rubber discs are placed directly over the thinned wall.
      • Sclerotherapy - a procedure consisting of administering a special hemostatic solution into the vein cavity.

    Distal splenorenal shunt

    Danger and complications of the disease

    The main danger of dilatation of the veins of the esophagus is considered to be excessive bleeding.

    In more than half of patients, rebleeding occurs in the first two years.

    There is only one way to prevent the development of varicose veins in the esophagus - timely treatment of diseases of the liver, heart and stomach. The load on the veins is also reduced if a person adheres to a balanced diet and does not get carried away with lifting weights.

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