Esophageal vein dilatation often does not manifest itself until a life-threatening complication appears - bleeding. Its danger lies in the fact that with bleeding there is a high probability of death. The possibility of repeated hemorrhage is also increased. You can increase life expectancy through regular examinations of the esophagus and stomach.
Causes
The main reason for the expansion of the veins of the esophagus is the 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 connective loose tissue, they expand with the occurrence of varicose veins in the future.
Consider the diseases in which this pathology is observed:
- Esophageal veins with cirrhosis are very common.
- Portal thrombosis (occurs in some diseases of the cardiovascular system).
- Malignant neoplasms in the pancreas and liver (they squeeze a vein due to their growth).
- Congenital malformations.
- Randu-Osler Syndrome.
Esophageal vein ectasia is less likely to occur due to the progression of arterial hypertension.
When does a serious condition occur?
A serious condition in a patient occurs as a result of:
- severe thyroid disorders;
- squeezing systematically the superior vena cava;
- Chiari disease (endophlebitis obliterating the hepatic vein with the appearance of their occlusion and thrombosis).
Varicose enlargement of the esophagus most often affects men after the age of fifty.
Why does esophageal vein dilation occur with cirrhosis? The principle is simple: with this pathology, instead of healthy cells, scar tissue forms on the liver. This complicates the movement of blood, stagnant phenomena occur in the portal portal vein system 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 healthy structure of the liver.
Symptoms
Symptoms of expansion of the veins of the esophagus depend on its cause. In varicose veins of the esophageal veins. At the initial stage of the onset of esophageal disease, they are almost absent, and a person may not be aware that he has altered varicose veins. However, sooner or later hemorrhage forms, and against its background 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; losing weight; dyspnea; abdominal pain; heart palpitations; melena (black feces due to blood impurities).
Esophageal varicose veins can slowly progress or develop rapidly. If the disease goes slowly, people do not suspect for a long time that they have varicose veins. Sometimes with a rapid course of the disease a few days before a dangerous bleeding in the chest, a feeling of heaviness appears.
Strong compression in the chest area can warn of fatal hemorrhage. This situation is dangerous, because with severe bleeding, mortality reaches 80%.
Diagnostic Methods
To prevent extensive bleeding, early diagnosis of esophageal dilatation is important. A diagnosis is made on the basis of fibroesophagoscopy, which allows you to determine the cause of the disease, the degree of development of venous dilatation, and the state of the vascular walls. When conducting an examination against a background of bleeding, it is impossible to establish the cause.
Roentgenography
Radiography can provide important information about the condition of the esophagus veins and the nature of the disease. When using a special contrast agent, the results of the study will be much more accurate. Ultrasound of the abdominal organs enhances the accuracy of diagnosis. To assess the level of coagulopathy, functional and liver tests are used. In the presence of concomitant diseases, additional laboratory and instrumental research methods are used.
Classification, degrees
The classification of esophageal varicose veins is based on the degree of venous lesion. There are four degrees. Treatment is prescribed depending on one of them. The higher the degree, the more likely surgical therapy.
- Expansion of the veins of the esophagus 1 degree. Weak severity of the clinical picture. 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 a few, the lumen is not filled. It is diagnosed only through endoscopy. It is important at the first degree to begin to be treated in a timely manner.
- 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 lesions: a sinuous course of veins, distinct viewing of veins in the lower part of the esophagus, veins in the esophagus occupy a third of the cavity, the esophageal mucosa is not changed. Diagnosis by x-ray, a curved vascular contour is clearly visible in the picture.
- The third degree of varicose veins of the esophagus. Such a diagnosis is most common. The patient has severe signs. In this case, as a rule, an operation is prescribed. The veins significantly swell, nodes that are constantly expanding clearly show up, occupy 2/3 of the space in the esophagus, the mucous membrane of the organ is very thinned. Gastroesophageal refluxes appear.
- The fourth degree of 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 cluster-like nodes, which are very prominent in the lumen of the organ.
Such a disease of the esophagus, regardless of degree, is incurable. However, one cannot ignore it. If a person goes to the doctor late or improperly treats the disease (he is self-medicating), varicose veins can cause death. Adequate treatment and timely access to a specialist increase the likelihood of a successful prognosis.
Treatment of esophageal varicose veins
The doctor needs to do everything to normalize the varicose enlarged node, constantly monitor the disease. Therapeutic measures are aimed at eliminating hemorrhagic shock and hypovolemia. In case of coagulation defects, a transfusion of freshly frozen plasma and an additional intravenous or intramuscular administration of “Vikasol” are prescribed.
The treatment of such a dangerous disease of the esophagus in any case should be complex, it is impossible without medical and surgical therapy, diet. The sooner the necessary measures are started, the higher the patient’s chance to survive. Further procedures should be aimed at supporting the normal functioning of the human body and preventing recurrence of bleeding.
Treatment with folk remedies
The basis of the conservative treatment of varicose veins of the esophagus is drug therapy. Folk recipes alone will not bring any benefit. 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 doused with a glass of boiling water. Cool the infusion. Drink in four doses during the day.
- Take in equal proportions dogrose (one tablespoon) and pour half a liter of water. Then boil for five minutes and cool. Drink half a glass throughout the day.
Diet
The basic nutritional requirement is fractionality. Three hours before bedtime should be the last meal.
There should be more such foods in the diet that contain:
- vitamin C (dill, parsley, any berries);
- vitamin E (sunflower oil, salad, onion);
- bioflavonoids (cherry berries);
- natural fiber;
- rutin (citrus fruits, tea, currants).
It is necessary to adhere to the drinking regimen. Excluded from the diet: strong coffee and tea; any alcoholic drinks; sweets; flour products; spice.
Food should not be too hot or cold.
What medications are used to treat esophageal dilation?
Medicines
The patient is prescribed a number of drugs whose effect is aimed at reducing venous pressure. The main tools 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 the juice of the stomach (antacids).
- Nitroglycerine. Must be used by the patient regularly.
- Vitamin Aids.
- Medications for the treatment of internal hemorrhages.
- Intravenous administration of colloidal medicines to the patient.
Surgical method
Intervention may be surgical or endoscopic.
Endoscopic surgery is done through a series of procedures: electrocoagulation; banding; venous ligation; electrocoagulation; treatment of veins with the help of the drug "Thrombin" or film; the use of a probe for the purpose of squeezing pathologically dilated veins, as well as tampons.
The destroyed areas of blood vessels during electrocoagulation are removed using the influence of a weak current. A bandage is used in some situations: small rubber discs are fixed above the changed vessels. A bleeding vein is pressed with rubber probes. The specialist fixes special gas cylinders in the cardia and squeezes the veins.
If it is impossible to conduct a direct intervention, endoscopic ligation is used. In this case, the affected esophageal veins are ligated using strong nylon loops or elastic rings. Thanks to this, narrowing of the veins can be achieved.
Among surgical interventions, sclerotherapy is often used. At the same time, a solution is injected into the affected veins through the esophagus lumen. The procedure needs to be repeated several times, and to consolidate the positive dynamics of the venous lumen, it must be performed up to four times a year.
Other types of venous expansion interventions:
- shunting (a stent is inserted through the liver connecting the hepatic and portal veins);
- stitching;
- anastomosis (the connection of the left renal and splenic veins is carried out);
- devascularization (bleeding veins are removed because they cannot be restored).
Prevention
To support the condition of the gastrointestinal tract and to avoid venous expansion of the esophagus, you can use preventive measures, which include:
- Fractional meals: Each serving should be small, at least six meals. These are the most effective measures to prevent the formation of venous esophageal varicose veins and reflux esophagitis.
- All cooked meals must be stewed or boiled. Smoked and fried should not be abused.
- It is necessary to exclude indigestible food from the menu.
- Drinking and smoking is strictly prohibited.
- Do not carry weights.
- It will be very useful to take choleretic drugs (preferably of plant origin). They successfully improve the activity of the liver, help to accelerate the excretion of bile from the bladder.
Forecast
In the presence of varicose veins of the esophagus, the prognosis cannot be positive. In medicine, there were no cases of ridding a patient of such a pathology forever. But in most cases it turns out to make life easier for a person. To do this, seek qualified help immediately after detecting unpleasant symptoms. Proper treatment in this situation will help alleviate painful symptoms and prevent blood loss.
Observations of people in the practice of doctors around the world speak about rather sad statistics. For example, more than 50% of patients with already appeared bleeding die. Most patients who survived the blood loss have a relapse. The time to relapse is usually 1-2 years.
Due to the special severity of the expansion of the veins, the long-term life of the patient is almost impossible. Frequent relapses of bleeding and the weakening of the body as a whole also leave their mark. A favorable prognosis can only be if the person visited the doctor on time and did not allow blood loss.