In the human body, there are a huge number of veins and blood vessels. Under the influence of negative factors and various diseases, they are deformed, varicose veins develop. This disease affects not only the lower limbs and pelvic organs. Quite often, doctors diagnose varicose veins of the esophagus.
Description of the disease
Under varicose veins of the esophagus is commonly understood as a disease of the venous system of the organ. It develops due to increased pressure in the portal or vena cava system. The vessels of the esophagus are closely connected with the venous system of the abdominal organs, especially with the portal vein system. An increase in pressure in it entails a violation of the outflow and stagnation of blood in the esophageal veins, which provokes the occurrence of esophageal varicose veins.
In recent years, the prevalence of the disease has increased greatly. This is due to the high incidence of hepatitis and other liver pathologies, alcoholism. The danger of the disease lies in the fact that half of the patients die after the first bleeding. The risk of repeated hemorrhages is high, and death is observed in 80% of cases. The disease is incurable. It is possible to increase the duration and quality of life of patients only with regular examinations and compliance with the therapeutic recommendations of doctors.
Main reasons
The main cause of esophageal varicose veins is the difference in pressure in the portal and vena cava systems. In a he althy body, this figure is about 6 mm Hg. Art. If it is in the range from 12 to 20 mm Hg. Art., there is an expansion of the anastomoses of the portal vein. This indicates the development of portal hypertension, which develops due to the appearance of various obstacles in the way of blood flow. It is she who leads to varicose veins and the occurrence of local bleeding.
There are other factors that increase the likelihood of developing the disease. These should include:
- cirrhosis of the liver;
- consistently high blood pressure;
- malignant neoplasms in the thyroid gland;
- blood clots in the hepatic vessels;
- thrombophlebitis;
- hepatitis;
- atherosclerosis;
- parasitic liver damage;
- chronic gastrointestinal diseases;
- esophageal angioma.
Based on these factors, the connection of the liver with the veins of the esophagus becomes noticeable. Indeed, the outflow of blood occurs through the gastric vein into the portal vein with the formation of an anastomosis. The latter is the largest vessel passing into the liver. The portal vein also collects blood from the stomach, spleen, intestines, and pancreas. Therefore, when the liver is damaged, pressure increases in both the portal and esophageal veins.
Clinical picture
According to medical statistics, esophageal varices are 2 times more common in men than in women. The average age of patients is 50 years. The course of the disease is individual in each case. The development of varicose veins can be rapid or slow. In the latter case, patients are unaware of he alth problems for a long time. Only some symptoms make it possible to understand that some changes are taking place in the body. These include:
- heartburn;
- belching air;
- difficulty swallowing food;
- chest discomfort and heaviness;
- palpitations
These signs are harbingers of esophagitis - inflammation of the esophageal mucosa that accompanies varicose veins.
The rapid development of the disease has a specific sign. This is a vascular pattern on the anterior abdominal wall, resembling the head of a jellyfish in outline. Later, when bleeding is already taking place, the clinical picture is supplemented by hematemesis, tachycardia, and hypotension. This condition is life-threatening and requires urgent hospitalization.
Degrees of disease progression
The pathological process has 2 forms: congenital and acquired. The first option is rare and is diagnosed in newborns. The main reason is the hereditary factor, as well as the complicated course of pregnancy. The acquired form is common, it is detected mainly in men over 50 years of age. Aboutthe main reasons were described a little higher.
There are also 4 degrees of esophageal varicose veins:
- At the first degree, the size of varicose veins is no more than 3 mm. Pathology is detected during endoscopic examination using a contrast agent. No clinical signs.
- The second degree is characterized by a change in the structure of the veins. They become tortuous, there is no bleeding. The diagnosis is confirmed by contrast radiography, which shows indistinct contours of the vessels and the presence of rounded protrusions.
- In the case of the third degree of varicose veins, there is a persistent expansion of certain parts of the vessels, the lumen of the veins is narrowed. Symptoms are pronounced and cause discomfort to the patient. There is a high risk of bleeding. The x-ray image shows formations on the esophageal mucosa in the form of polyps.
- In the fourth degree, thinning of the vascular mucosa occurs, the formation of polyps on it. Varicose veins block the lumen of the esophagus. This condition of the patient is regarded as critical.
Determining the degree of development of the pathological process allows you to choose the most effective therapeutic tactics.
Possible Complications
Bleeding with esophageal varicose veins is considered the most dangerous complication. It can go unnoticed, or it can pose a threat to the life of the patient. Its main symptom is vomiting of scarlet blood. Even subtle and irregular bleeding can lead to iron deficiency anemia.
Among the main reasonsof such a complication, the following can be distinguished:
- febrile condition;
- straining;
- rise in blood pressure;
- overeating;
- weight lifting.
Bleeding sometimes occurs suddenly, but if it becomes profuse, it is fatal. Its harbingers are a sensation of "tickling" in the throat, a s alty taste in the mouth. Shortly after these symptoms, vomiting of blood suddenly appears. In rare cases, fibroesophagoscopy results in bleeding, which indicates the need for early diagnosis of the disease.
Diagnostic Methods
Suspicion of esophageal varicose veins by symptoms is quite difficult. The disease is usually detected at the stage of bleeding. However, a preliminary diagnosis can be made in patients at risk. To clarify it, a comprehensive examination of the body is prescribed, which consists of the following activities:
- General and biochemical blood tests (allows you to evaluate the work of the body as a whole, to identify the presence of inflammatory processes and the degree of blood loss).
- Ultrasound of the abdominal organs (required to detect pathologies of the liver and other organs).
- Plane x-ray of the abdominal cavity (this diagnostic method complements ultrasound).
- FGDS (the most informative study with which you can determine the source of hemorrhage, assess the condition of the esophageal mucosa).
Based on the results of the examination, the doctor confirms or refutes the preliminary diagnosis, gives a conclusion aboutpossible root cause.
Drug therapy
Treatment of esophageal varicose veins depends on the degree of the disease, the severity of clinical manifestations. In the absence of extensive bleeding, conservative therapy is prescribed. Otherwise, hospitalization of the patient and surgical intervention are required.
Conservative treatment is carried out using drugs from the following groups:
- Hemostatics or coagulants. They increase blood clotting, promote accelerated healing of wounds and erosions. These medications include Vikasol (vitamin K), thrombin preparations.
- Antacids. Eliminate the effects of acid reflux, prevent inflammation of the walls of the esophagus.
- Beta-blockers and nitroglycerin agents. Used to relieve pressure.
- Vitamin and mineral complexes. Stop anemia and help to fill the lack of iron, potassium, calcium in the body.
The choice of specific drugs and their dosage is carried out by the doctor. All medicines have contraindications, so they are selected individually.
Endoscopic treatments
Treatment of esophageal varicose veins through endoscopic interventions to stop bleeding shows good results. The techniques were first described in 1939, but they began to be put into practice only in the 70s of the last century.
Intervention involves the use of sclerosants with a different mechanismactions. There are 2 ways to carry out endoscopic sclerosis of the esophagus: intravasal and paravasal. In the first case, connective tissue develops at the site of localization of the thrombosed varicose vein after the introduction of a sclerosant. This method of treatment is rarely used today, as it is accompanied by many complications. With paravasal intervention, the sclerosant is injected into the submucosal node. After that, tissue scarring occurs at the site of the lesion and subsequent compression of the veins of the esophagus. This method is considered the most gentle.
Balloon tamponade
The use of balloon tamponade helps to improve the results of sclerotherapy. This method of treatment involves stopping bleeding by squeezing the bleeding node. It is dangerous enough to be performed by an experienced technician.
The main instrument is a probe equipped with a balloon. Stopping bleeding is carried out by inflating the gastric balloon and traction. In this case, the esophageal balloon remains intact. Due to this, a tamponade of dilated veins is created, the intensity of bleeding decreases. The effectiveness of this procedure is 90%.
Surgery
Surgical treatment of esophageal varicose veins involves one of the following types of interventions:
- transjugular intrahepatic portosystemic shunt (TIPS);
- bypass;
- devascularization.
TIPS technique involves fabrication of an intrahepatic prosthetic valve andsubsequent installation of a metal stent in the vein ducts. With this operation, it is almost always possible to stop bleeding when other methods of therapy are ineffective.
Shunting is as close as possible to the TIPS technique in terms of its effectiveness, but it is more traumatic. In addition, the risk of developing hepatic encephalopathy increases.
Devascularization operations for esophageal varicose veins involve the intersection of the organ and the subsequent imposition of an anastomosis. They help stop bleeding. However, the causes of portal hypertension are not eliminated, so relapses occur quite often.
Lifestyle
With varicose veins of the 1st degree, in order to avoid bleeding and other complications, you must follow simple rules. First of all, you should regularly undergo examinations with a doctor and take a list of tests. It is important to avoid excessive physical activity and eat a special diet.
Diet for esophageal varicose veins is quite simple. Food should be taken often (up to 6 times a day), but in small portions. It must be heat treated. It is best to avoid excessively hot or cold drinks. You will also have to give up spicy, fried and s alty foods.
Legumes, seafood, fresh vegetables and fruits, as well as a variety of cereals are allowed. The ban includes confectionery, tea and coffee, sugar. It is better to cook food by steaming or baking in the oven. Do not forget about the drinking regimen. Per day you need to consume up totwo liters of clean water.
Treatment of esophageal varicose veins with folk remedies, as practice shows, is ineffective. Such funds can be used in the initial stages of the disease and only after agreement with the doctor. Various decoctions are used only to strengthen the body.
Prognosis for recovery
At the initial stages of the development of the pathological process, subject to timely treatment, adherence to a diet, it is possible to stop bleeding in 80% of cases. However, almost half of patients relapse within the next two years. They are at risk, therefore they are subject to constant monitoring by doctors. Survival of patients with severe cirrhosis is low.
