Dilated esophageal veins often don't show up until the life-threatening complication of bleeding occurs. Its danger lies in the fact that with bleeding there is a high probability of death. Increased is the possibility of re-hemorrhage. You can increase life expectancy through regular examinations of the esophagus and stomach.
Reasons
The main cause of esophageal veins is high pressure in the portal vein, that is, portal hypertension. Because of this, blood passes through the vessels of the stomach into the veins of the esophagus, the pressure in this area almost constantly rises sharply. Since the vessels are located in the loose connective tissue, they expand with the onset of varicose veins in the future.
Consider the diseases in which this pathology is observed:
- Dilation of the veins of the esophagus with cirrhosis is very common.
- Portal thrombosis(occurs with some diseases of the cardiovascular system).
- Malignant neoplasms in the pancreas and liver (they compress the vein due to their growth).
- Congenital malformations.
- Randu-Osler syndrome.
Ectasia of the esophageal veins is less likely to occur due to the progression of arterial hypertension.
When does a serious condition occur?
Severe condition in a patient is the result of:
- severe thyroid disorders;
- squeezing the superior vena cava systematically;
- Chiari disease (endophlebitis obliterans of the hepatic vein with the appearance of their occlusion and thrombosis).
Esophageal varicose veins are most common in men over the age of fifty.
Why does esophageal vein enlargement occur in cirrhosis of the liver? The principle is simple: with this pathology, instead of he althy cells, scar tissue forms on the liver. This impedes the movement of blood, congestion occurs in the system of the portal vein of the liver, which cause varicose veins in the lower (distal) zone of the esophagus. This chronic process is accompanied by a violation of the he althy structure of the liver.
Symptoms
Symptoms of esophageal varicose veins depend on the cause. Varicose veins of the esophageal veins have a progressive course. At the initial stage of the occurrence of diseases of the esophagus are almost absent, and a person may not realize that he has altered varicose veins. However, sooner or later hemorrhage is formed, and on itbackground, the patient is diagnosed.
Hemorrhage can have a different volume - both mild bleeding and massive (the disease in this case quickly ends in death). The patient develops the following symptoms due to chronic hemorrhage: general weakening; hypochromic anemia; belching; adynamia; severe pallor; weight loss dyspnea; abdominal pain; cardiopalmus; melena (black feces due to blood impurities).
Esophageal varicose veins can progress slowly or develop rapidly. If the disease passes slowly, people do not suspect for a long time that they have varicose veins. Sometimes, with a rapid course of the disease, a feeling of heaviness in the chest appears in the days before dangerous bleeding.
Strong compression in the chest area can warn of fatal hemorrhage. This situation is dangerous, because with severe bleeding, the mortality rate reaches 80%.
Diagnostic Methods
Early diagnosis of esophageal veins is important to prevent major bleeding. The diagnosis is made on the basis of information from fibroesophagoscopy, which allows you to determine the cause of the disease, the degree of development of venous dilatation, the condition of the vascular walls. When conducting an examination against the background of bleeding, it may not be possible to determine the cause.
X-ray
Important information about the condition of the esophageal veins and the nature of the disease can provide radiography. When using a special contrast agent, the results of the study will be much moreaccurate. Ultrasound of the abdominal organs enhances the accuracy of diagnosis. Functional and liver tests are used to assess the level of coagulopathy. In the presence of concomitant diseases, additional laboratory and instrumental research methods are used.
Classification, degrees
Classification of esophageal varices is based on the degree of venous involvement. There are four degrees. Treatment is prescribed depending on one of them. The higher the grade, the more likely surgical therapy.
- Expansion of the veins of the esophagus 1 degree. Weak clinical presentation. The patient has almost no complaints. During the examination, the following are noted: venous expansion is not more than three millimeters, there is no ectasia of the veins or only single ones, the lumen is not filled. Diagnosed only through endoscopy. It is important to start treatment in a timely manner at the first degree.
- Expansion of the veins of the esophagus 2 degrees. This is a disease of a more pronounced nature, in which there are symptoms of venous damage: a tortuous course of the veins, a clear viewing of the veins in the lower part of the esophagus, the veins in the esophagus occupy a third of the cavity, the esophageal mucosa is not changed. Diagnosis by X-ray, the curved vascular contour is clearly visible in the picture.
- Third degree of esophageal varicose veins. This is the most common diagnosis. The patient has severe symptoms. In this case, as a rule, an operation is prescribed. The veins swell significantly, distinctlyknots appear, constantly expanded, occupy 2/3 of the space in the esophagus, the mucous membrane of the organ is very thin. Gastroesophageal refluxes appear.
- Fourth degree expansion of the veins of the esophagus. A severely neglected last stage, which is accompanied by a significant lesion of the esophageal mucosa, bleeding, a large number of grape-shaped nodes, strongly protruding in the lumen of the organ.
Such a disease of the esophagus, regardless of the degree, is incurable. However, it cannot be ignored. If a person goes to the doctor late or treats the disease incorrectly (self-medicates), varicose veins can cause death. Adequate treatment and timely access to a specialist increase the likelihood of a favorable prognosis.
Treatment of esophageal varicose veins
The doctor needs to do everything to bring the varicose veins back to normal, constantly monitor the disease. Therapeutic measures are aimed at eliminating hemorrhagic shock and hypovolemia. In case of coagulation defects, transfusion of fresh frozen plasma and additional intravenous or intramuscular injection of Vikasol are prescribed.
Treatment of such a dangerous disease of the esophagus in any case should be comprehensive, it is impossible without medical and surgical therapy, diet. The sooner the necessary measures are started, the higher the patient's chance of survival. Further procedures should be aimed at supporting the normal functioning of the human body and preventing the recurrence of bleeding.
Treatment with folk remedies
The basis of conservative treatment of esophageal varicose veins is drug therapy. Folk recipes alone will not bring benefits. Traditional medicine is used only as an auxiliary therapeutic method. At home, the use of such folk remedies is allowed:
- One tablespoon of sophora should be poured over with a glass of boiling water. Cool the infusion. Drink four times a day.
- Take equal proportions of wild rose (one tablespoon each) and pour half a liter of water. Then boil for five minutes and cool. Drink half a glass throughout the day.
Diet
The main requirement for nutrition is fractionality. Three hours before bedtime should be the last meal.
The diet should include more of these foods that contain:
- vitamin C (dill, parsley, any berries);
- vitamin E (sunflower oil, lettuce, onion);
- bioflavonides (cherries);
- natural fiber;
- rutin (citrus, tea, currant).
You need to stick to the drinking regimen. Excluded from the diet: strong coffee and tea; any alcoholic drinks; sweets; flour products; spices.
Food should not be too hot or too cold.
What medications are used to treat esophageal veins?
Medicines
The patient is prescribed a number of drugs whose effect is aimed at reducing venous pressure. The main remedies that are used in the treatment of esophageal varicose veins:
- Beta blockers. Reduce the likelihood of hemorrhage, stabilize pressure. For the same purpose, calcium preparations are prescribed.
- Means that regulate the degree of acidity of gastric juice (antacids).
- Nitroglycerin. Should be used regularly by the patient.
- Vitamin products.
- Drugs to treat internal hemorrhages.
- Intravenous administration of colloidal drugs to a patient.
Surgical method
The intervention can be surgical or endoscopic.
Endoscopic surgery is done through a series of procedures: electrocoagulation; bandaging; venous ligation; electrocoagulation; treatment of veins with the drug "Thrombin" or film; use of a probe for the purpose of squeezing pathologically dilated veins, as well as tamponade.
Destroyed areas of blood vessels during electrocoagulation are removed using the influence of a weak current. In some situations, the installation of a bandage is used: small rubber discs are fixed over the changed vessels. The bleeding vein is pressed with rubber probes. The specialist fixes special gas cylinders in the cardia and squeezes the veins.
If direct intervention is not possible, endoscopic ligation is used. The affected esophageal veins are then ligated with strong nylon loops or elastic rings. Thanks to this, narrowing of the veins can be achieved.
Sclerotherapy is often used among surgical interventions. At the same time, a solution is injected into the affected veins through the esophageal lumen. The procedure must be repeated several times, and to consolidate the positive dynamics of the venous lumen, it must be carried out up to four times a year.
Other types of interventions for venous dilation:
- bypass (a stent is inserted through the liver, connecting the hepatic and portal vein);
- stitching;
- anastomosis (connection of the left renal and splenic vein is carried out);
- devascularization (bleeding veins are removed as they cannot be repaired).
Prevention
Gastrointestinal support and venous dilatation of the esophagus can be avoided through preventive measures that include:
- Split Meals: Each serving should be small, at least six meals. These are the most effective measures to prevent the formation of venous esophageal varices and reflux esophagitis.
- All cooked meals must be stewed or boiled. Do not abuse smoked and fried.
- It is necessary to exclude indigestible food from the menu.
- Drinking and smoking are strictly prohibited.
- Weights must not be carried.
- It will be very useful to take choleretic agents (preferably of plant origin). They successfully improve the activity of the liver, help to accelerate the removal of bile from the bladder.
Forecast
In the presence of varicose esophagus, a positive prognosis cannot bemaybe. In medicine, there were no cases of delivering a patient from such a pathology forever. But in most cases, it turns out to make life easier for a person. To do this, you need to seek qualified help immediately after the discovery of unpleasant symptoms. Proper treatment in this situation can help relieve symptoms and prevent blood loss.
Observations of people in the practice of doctors around the world speak of rather sad statistics. For example, more than 50% of patients who already bleed will die. Most of the patients who were able to survive after blood loss, there is a relapse. The time to recurrence of the disease is usually 1-2 years.
Due to the severity of the varicose veins, the long-term life of the patient is practically impossible. Frequent recurrences of bleeding and weakness of the body as a whole also leave their mark. A favorable prognosis can only be if a person goes to the doctor in time and does not allow blood loss.
