The human body has a huge number of veins and blood vessels. Under the influence of negative factors and various diseases, they are deformed, and varicose veins develop. This ailment affects not only the lower limbs and pelvic organs. Quite often, doctors diagnose esophageal varicose veins.
Disease Description
Under the esophagus varicose is usually 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, provokes the occurrence of varicose veins of the esophagus.
In recent years, the prevalence of the disease has greatly increased. This is due to the high frequency of detection of hepatitis and other liver pathologies, alcoholism. The danger of the disease is that half of the patients die after the first bleeding. The risk of repeated hemorrhages is high, and a fatal outcome is observed in 80% of cases. The disease is incurable. To increase the duration and quality of life of patients is possible only with regular examination and compliance with the therapeutic recommendations of doctors.
Main reasons
The main cause of varicose veins of the esophagus is considered the pressure difference in the portal and vena cava system. In a healthy body, this figure is about 6 mm Hg. Art. If it is in the range of 12 to 20 mmHg. Art., there is an expansion of the portal vein anastomoses. 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, the presence of which increases the likelihood of developing an ailment. These include:
- cirrhosis of the liver;
- consistently high blood pressure;
- malignant neoplasms in the thyroid gland;
- blood clots in the liver vessels;
- thrombophlebitis;
- hepatitis;
- atherosclerosis;
- parasitic damage to the liver;
- chronic diseases of the gastrointestinal tract;
- esophagus angioma.
Based on these factors, the connection of the liver with the veins of the esophagus becomes noticeable. Indeed, blood outflow 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, with liver damage, pressure rises in both the portal and esophageal veins.
Clinical picture
According to medical statistics, esophageal varicose veins are 2 times more common in men than in women. The average age of patients is 50 years. The course of the disease in each case is individual. The development of varicose veins can be rapid or sluggish. In the latter case, patients have long been unaware of health problems. Only a few symptoms make it clear that some changes are taking place in the body. These include:
- heartburn;
- burping air;
- difficulties in the process of swallowing food;
- discomfort and heaviness in the chest;
- heart palpitations.
The listed symptoms are harbingers of esophagitis - inflammation of the mucous membrane of the esophagus 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 shape of a jellyfish head. Later, when bleeding already takes place, the clinical picture is supplemented by bloody vomiting, tachycardia, hypotension. This condition is dangerous to human life and requires urgent hospitalization.
The degree of development of the disease
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, detected mainly in men older than 50 years. The main reasons were described a little higher.
There are also 4 degrees of esophageal varicose veins:
- In the first degree, the size of the varicose nodes is not more than 3 mm. Pathology is detected during an endoscopic examination using a contrast medium. Clinical signs are absent.
- For the second degree, a change in the structure of the veins is characteristic. They become sinuous, there is no bleeding. The diagnosis is confirmed by contrast radiography, which shows the fuzzy 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 individual parts of the vessels, the lumen of the veins is narrowed. Symptoms are pronounced and cause discomfort to the patient. However, there is a high risk of bleeding. On the x-ray image, formations on the mucous membrane of the esophagus in the form of polyps are visible.
- With the fourth degree, there is a thinning of the vascular mucosa, the formation of polyps on it. Varicose nodes 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 varicose veins of the esophagus is considered the most dangerous complication. It can pass unnoticed, and can pose a threat to the life of the patient. Its main symptom is vomiting of scarlet blood. Even inconspicuous and irregular bleeding can lead to iron deficiency anemia.
Among the main causes of this complication are the following:
- fever;
- straining;
- blood pressure rise;
- binge eating;
- weight lifting.
Bleeding sometimes occurs suddenly, but if it becomes profuse, it leads to death. Its precursors are a tickling sensation in the throat, a salty taste in the mouth. Shortly after these symptoms, vomiting of blood suddenly appears. In rare cases, fibroesophagoscopy leads to bleeding, which indicates the need for early diagnosis of the disease.
Diagnostic Methods
It is quite difficult to suspect esophageal varicose veins according to symptoms. The disease is usually detected at the stage of bleeding. However, a preliminary diagnosis can be made to patients at risk. To clarify it, a comprehensive examination of the body is prescribed, which consists of the following measures:
- General and biochemical blood tests (allow 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 (necessary to identify pathologies of the liver, other organs).
- Survey radiography 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 mucous membrane of the esophagus).
According to the results of the examination, the doctor confirms or refutes the preliminary diagnosis, gives a conclusion about its possible root cause.
Drug therapy
Treatment of varicose veins of the esophagus depends on the degree of the disease, the severity of the 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 coagulation, contribute to the accelerated healing of wounds and erosion. Such medicines 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 reduce pressure.
- Vitamin and mineral complexes. Stop anemia and help make up for the lack of iron, potassium, calcium in the body.
The choice of specific drugs and their dosage is carried out by the doctor. All drugs have contraindications, so they are selected individually.
Endoscopic treatments
Treatment of esophageal varicose veins with endoscopic procedures to stop bleeding shows good results. The first methods were 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 mechanism of action. There are 2 ways to carry out endoscopic sclerosis of the esophagus: intravasal and paravasal. In the first case, at the site of localization of the thrombosed varicose node, connective tissue develops after the introduction of a sclerosant. This method of treatment is rarely used today, since it is accompanied by many complications. With paravasal intervention, sclerosant is introduced into the submucous node. After this, tissue scarring and subsequent compression of the veins of the esophagus occur at the site of the lesion. This method is considered the most gentle.
Balloon tamponade
The use of balloon tamponade helps to improve the results of sclerotherapy. This treatment involves stopping bleeding by squeezing a bleeding node. It is quite dangerous, so it should be performed by an experienced specialist.
The main instrument is a probe equipped with a balloon. The stopping of bleeding is carried out by inflating a gastric balloon and stretching. In this case, the esophageal balloon remains intact. Due to this, tamponade of dilated veins is created, the intensity of bleeding decreases. The effectiveness of this procedure is 90%.
Surgical intervention
Surgical treatment of esophageal varicose veins involves one of the following interventions:
- transjugular intrahepatic portosystemic shunting (TIPS);
- shunting;
- devascularization.
The TIPS technique involves the manufacture of an intrahepatic artificial valve and subsequent installation of a metal stent in the vein ducts. With the help of this operation, it is almost always possible to stop the bleeding, when other methods of therapy are ineffective.
Bypass surgery is as close as possible to the TIPS technique in its effectiveness, but it is more traumatic. In addition, the risk of developing hepatic encephalopathy increases.
Devascularizing operations for varicose veins of the esophagus involve the intersection of the organ and the subsequent application 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 1 degree, in order to avoid the appearance of bleeding and other complications, it is necessary to adhere to simple rules. First of all, you should regularly undergo examinations by a doctor and take a list of tests. It is important to avoid excessive physical exertion and adhere to a special diet.
The diet for varicose veins of the esophagus 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 better to avoid excessively hot or cold drinks. You will also have to give up spicy, fried and salty dishes.
Beans, seafood, fresh vegetables and fruits, as well as a variety of cereals are allowed. Confectionery, tea and coffee, sugar fall under the ban. It is better to cook food for a couple or bake in the oven. Do not forget about the drinking regimen. Up to two liters of clean water must be consumed per day.
Treatment of varicose veins of the esophagus with folk remedies, as practice shows, is ineffective. It is permissible to use such funds in the initial stages of the disease and only after consultation with the doctor. Various decoctions are used only to strengthen the body.
Prognosis for recovery
In the initial stages of the development of the pathological process, subject to timely treatment and diet, it is possible to stop bleeding in 80% of cases. However, almost half of the patients relapse within the next two years. They are at risk, therefore, are subject to constant monitoring by doctors. Survival of patients with severe cirrhosis is low.