Varicose veins of the esophagus is a term for venous dilatation in the lower part of the esophagus, which is the result of disturbances in the blood flow in the portal vein and, consequently, of the gastroesophageal plexus by an excessive amount of flowing blood that seeks outflow from the heart.
Due to the fact that with varicose veins of the esophagus in 90% of cases corresponds to cirrhosis, yellowing of the skin and eye proteins, loss of appetite, weight loss, ascites, abdominal pain and nausea may appear.
The most dangerous symptom of this disease is associated with hemoptysis, mixed with blood vomiting, tarry stool and weakness.
Causes of
Esophageal varices in its lower part arises from stagnant phenomena in the portal portal vein system that occur with thrombosis and cirrhosis of the liver. The cause of this disease in the upper division is malignant goiter. The veins of the liver contract, which makes the blood flow difficult for them. Phlebectasia of the esophagus also appears as a complication in diseases of the heart and spleen.
The factors that cause this disease:
- portal vein stenosis, characteristic of the younger generation, resulting from thrombosis, sclerosis;
- liver diseases that occur in old age - cirrhosis, amyloidosis, echinococcosis;
- Chiari disease;
- esophageal angioma;
- Malignant goiter;
- vascular pathology.
Varicose veins of the esophagus most often occurs in the following categories of patients :
- in men;
- in people older than 50 years;
- in patients with a history of pancreas, stomach, heart, chronic cirrhosis.
The appearance of bleeding is affected not so much by the level of pressure as by its sharp fluctuations. The risk of rupture is high also in those patients who suffer from vascular diseases, negatively affecting the structure of the walls of blood vessels.
Classification of
Classification of the disease of varicose veins of the esophagus has changed several times, however, the version from 1997 for esophageal veins that divides the disease according to the degrees is now used:
- First degree .The veins in diameter reach 5 mm, markedly elongated, located in the lower level of the organ.
- Second degree .The veins are convoluted, in diameter reach 10 mm, located in the middle part of the organ.
- Third degree .Vessels are expanded more than up to 10 mm, the walls are tense, thin, located side by side, winding in the direction, have red spots on the outer surface.
If varicose veins of the esophagus still caused internal bleeding, then according to statistics - after it only 50% of patients survive. More than half of the survivors after bleeding suffer from the disease for 1-3 years with relapse of this disease and are forced to start treatment again.
Varicose veins of the 1st degree
The clinical picture is mild. The patient has practically no complaints. At inspection observe: the expansion of veins not strong up to 3 mm., Ectasia of veins is not present, or only single, the gleam is not filled. It is only diagnosed with endoscopy. At the first degree it is important to begin treatment as soon as possible.
Varicose veins of the 2nd degree
The irregularity of the vessels is well traced, as well as there are nodules whose size exceeds 3 millimeters. In this case, the mucosa of the esophagus remains intact, without any violation of its integrity.
When performing the study, it is possible to diagnose large ones in protrusions of vessels. Treatment should be done in a timely manner, only in this way it will be possible to get rid of the unpleasant symptoms of the disease at the initial stage. Bleeding is not typical at this stage.
Varicose veins of grade 3
The most common diagnosis. The patient has severe symptoms. As a rule, in this case, an operation is appointed. The veins are strongly swollen, the nodes clearly appear, constantly enlarged, occupy 2/3 of the esophagus, the mucosa of the esophagus is severely thinned. There are gastroesophageal refluxes.
Varicose veins of the 4th degree
This degree of disease is exhibited when numerous nodules of veins are detected in the esophagus that do not subside and have a thinned surface. Numerous erosions are found on the mucous layer. Patients register, in addition to the symptoms of esophagitis, a salty taste in the mouth. The fourth degree most often leads to spontaneous bleeding.
Symptoms of varicose veins of the esophagus
The first few years, varicose veins of the esophagus can flow without any visible symptoms. Sometimes there are rare attacks of heartburn, a weak heaviness in the chest, belching. Some patients complain of difficulty with swallowing food.
Symptoms of progressive disease usually appear several days before the onset of bleeding. Signs of them consist in severe heaviness in the chest and deterioration of the general well-being of the patient. In other patients, symptoms can be expressed in the manifestation of ascites.
In addition, symptoms of venous gullet disease can manifest as a "jellyfish head".This phenomenon is a certain pattern, which is rather well seen on the anterior wall of the abdominal cavity by various pathologically formed convex vessels or veins.
After the veins burst, there is a severe bleeding , accompanied by characteristic symptoms:
- severely reduced blood pressure;
- bloody impurities in vomiting;
- bloody impurities in feces;
- marked tachycardia.
With slight bleeding, a person may feel some weakness, malaise, as well as symptoms of anemia. Diagnosis of esophagus varicose with the help of laboratory tests, ultrasound examination of the abdominal cavity organs, if necessary, conduct X-ray studies and esophagoscopy.
Diagnosis
Diagnosis is issued based on complaints, external examination, identification of primary diseases. Instrumental studies include:
- laboratory blood test data;
- radiography with contrast agent;
- is an esophagoscopy which must be performed carefully because of the risk of possible bleeding.
When diagnosing, all possible causes should be taken into account and excluded, only then it will be possible to definitively and accurately determine the root cause of bleeding and changes in the esophagus.
Treatment of varicose veins of the esophagus
If symptoms of varicose veins of the esophagus occur, treatment is performed only in the intensive care unit. The main classification of non-surgical procedures is aimed at preventing and eliminating bleeding( haemostatic therapy) by reducing pressure in the vessels:
- Drug treatment in the form of vitamins, astringents and antacids( drugs that reduce acidity in the stomach).This method is aimed at the prevention of peptic esophagitis, in which inflammation can go to the walls of the vessels, causing bleeding.
- Blood transfusion, erythrocyte mass, plasma;
- Introduction of colloidal solutions;
- Receiving blood-reducing and vasoconstrictive drugs.
In cases where these methods are not sufficient to fundamentally stop bleeding and there is a risk of re-vascular damage in the near future, resorts to operation :
- of the transgular intrahepatic portosystemic shunting( TIPS);
- bypass;
- devascularization.
There is also considerable experience with the use of minimally invasive endoscopic interventions to eliminate bleeding from the enlarged esophageal veins. There are 2 ways of carrying out endoscopic esophageal sclerosis:
- intravasal;
- Paravasal.
The intravasal method of introducing sclerosant involves the development of connective tissue at the site of localization of the thrombosed varicose node. In the paravasal method, when the sclerosant is injected into the submucosal layer, scarring of paravasal tissue and subsequent compression of the enlarged esophagus veins occurs. This method is more sparing and has fewer complications.
Diet of
Patients need to follow a strict diet all their life, despite the state of health:
- frequent meals in small portions.
- the exclusion of hot and cold dishes.
- shows low-fat broths and soups, cereals in diluted milk or water, compotes, fruits in grated form, vegetables stewed.
- contraindicated acute, acidic, salty, fatty and fried meat products;it is necessary to cook everything in a puree.
Categorically contraindicated alcohol, carbonated drinks, beer.
Prevention
To prevent the transformation of healthy esophagus veins into pathological, varicose, in the first place, it is necessary to monitor the liver and timely treat all of its diseases. To do this, experts advise to consult them regularly for advice and follow all recommendations.
Prognosis for life
Unfortunately, varicose veins of the esophagus are incurable. However, in the case of timely diagnosis, adequate maintenance treatment will significantly improve the quality of life of the patient and help prevent a formidable condition - bleeding.
Mortality with bleeding already existing from varicose veins of the esophagus is more than 50% and depends on the severity of the underlying disease and the state of the organism as a whole. In surviving patients after bleeding in 75% of cases within the next 1-2 years there is a relapse.
In general, the prognosis of long-term survival of patients with this disease remains low, which is mainly the fault of the main severe liver disease.