Varicose veins of the esophagus - a term for venous dilatation in the lower part of the esophagus, resulting from impaired blood flow in the portal vein and, consequently, the gastroesophageal plexus with excessive amount of flowing blood, which seeks outflow from the heart.
Due to the fact that with varicose veins of the esophagus in 90% of cases corresponds to cirrhosis of the liver, yellowing of the skin and eye proteins, loss of appetite, weight loss, ascites, abdominal pain and nausea may occur.
The most dangerous symptom of this disease is associated with hemoptysis, vomiting mixed with blood, tarry stools and weakness.
Varicose veins of the esophagus in its lower part arises due to stagnation in the portal portal vein of the liver, which appear during thrombosis and cirrhosis of the liver. The cause of this disease in the upper section is malignant goiter. Liver veins are compressed, which makes blood flow through them difficult. Phlebectasia of the esophagus also appears as a complication in diseases of the heart and spleen.
Factors causing this disease:
- stenosis of the portal vein, characteristic of the younger generation, arising from thrombosis, sclerosis;
- liver diseases that occur in old age - cirrhosis, amyloidosis, echinococcosis;
- Chiari disease;
- angioma of the esophagus;
- malignant goiter;
- vascular pathology.
Varicose veins of the esophagus most often occurs in the following categories of patients:
- in men;
- in people over 50;
- in patients with a history of diseases of the pancreas, stomach, heart, chronic cirrhosis.
The appearance of bleeding is affected not so much by the level of pressure, as by sharp fluctuations. The risk of rupture is high in those patients who suffer from vascular diseases that adversely affect the structure of the vascular walls.
The classification of the disease of varicose veins of the esophagus has changed several times, however, now the 1997 version of the esophagus veins is used, dividing the disease by degrees:
- First degree The veins in diameter reach 5 mm, markedly elongated, located in the lower level of the organ.
- Second degree Veins tortuous, in diameter reach 10 mm, located in the middle part of the body.
- Third degree The vessels are expanded to more than 10 mm, the walls are strained, thin, located side by side, meander in the direction, have red spots on the outer surface.
If varicose veins of the esophagus still caused internal bleeding, then according to statistics, only 50% of patients survive after it. More than half of the patients who survived after bleeding face a recurrence of this disease for 1-3 years and are forced to re-start treatment.
Varicose veins of 1 degree
The clinical picture is mild. The patient has almost no complaints. During the examination they observe: the dilation of the veins is not strong up to 3 mm., There is no vein ectasia, or only a few, the lumen is not filled. Diagnosed only with endoscopy. When the first degree is important as soon as possible to begin treatment.
Varicose veins 2 degrees
The unevenness of the vessels is well traced, there are also nodules that are larger than 3 millimeters. At the same time, the mucous membrane of the esophagus remains intact, without any violation of its integrity.
When conducting a study, it is possible to diagnose large ones in vascular protrusions. Treatment should be carried out in a timely manner, the only way to get rid of the unpleasant symptoms of the disease at the initial stage. Bleeding is not typical at this stage.
Varicose veins 3 degrees
The most common diagnosis. The patient has severe symptoms. As a rule, in this case, appoint an operation. The veins are strongly swollen, the nodes clearly show through, constantly widened, occupy 2/3 of the esophagus, the mucous membrane of the esophagus is greatly thinned. Gastroesophageal refluxes occur.
4th degree varicose veins
This degree of disease is exposed when numerous venous nodules are revealed in the esophagus that do not fall down and with a thinned surface. On the mucous layer are found numerous erosion. Patients register, in addition to signs 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 occur without visible symptoms. Sometimes there are rare attacks of heartburn, weakness in the chest, belching. Some patients complain of difficulty swallowing food.
Symptoms of progressive disease usually appear several days before the onset of bleeding. Signs of them are severe chest pain and a deterioration in the general well-being of the patient. In other patients, symptoms may be expressed in the manifestation of ascites.
In addition, the symptoms of the disease of the veins of the esophagus can manifest itself in the form of a "jellyfish head". This phenomenon is a certain pattern, which is quite well seen on the front wall of the abdominal cavity by various pathologically formed convex vessels or veins.
After the veins rupture, there is severe bleeding, accompanied by characteristic symptoms:
- greatly reduced blood pressure;
- bloody impurities in vomiting;
- bloody impurities in stool masses;
- severe tachycardia.
With a slight bleeding, a person may feel some weakness, malaise, as well as symptoms of anemia. They diagnose esophageal varices with the help of laboratory tests, an ultrasound examination of the abdominal organs, and, if necessary, x-rays and esophagoscopy.
The diagnosis is made on the basis of complaints, external examination, and detection of primary diseases. Instrumental studies include:
- laboratory data of blood tests;
- radiography with a contrast agent;
- esophagoscopy that needs to be done carefully due to the risk of possible bleeding.
When making a diagnosis, 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 veins of the esophagus.
Treatment of varicose veins of the esophagus
If symptoms of esophageal varicose veins occur, treatment is carried out only in the intensive care unit or intensive care. The main classification of non-surgical procedures is aimed at preventing and eliminating bleeding (hemostatic therapy) by reducing the pressure in the vessels:
- Drug treatment in the form of taking vitamins, astringent drugs 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 blood vessels, causing bleeding.
- Blood transfusion, erythrocyte mass, plasma;
- The introduction of colloidal solutions;
- Acceptance of hematopoietic and vasoconstriction drugs.
In cases where the listed methods are not sufficient for a thorough stop of bleeding and there is a risk of repeated damage to the blood vessels in the near future, they resort to surgery:
- transjugular intrahepatic portosystemic shunting (TIPS);
Also, there is currently considerable experience with the use of minimally invasive endoscopic interventions to eliminate bleeding from the dilated esophageal veins. There are 2 ways to carry out endoscopic sclerosis of the esophagus:
The intravasal method of introducing the sclerosant involves the development of connective tissue at the site of localization of the thrombosed varicose node. With the paravasal method, when the sclerosant is injected into the submucous layer, the paravasal fiber is scarred and the esophagus is then squeezed. This method is more gentle and has fewer complications.
Patients need to follow a strict diet throughout their lives, despite their well-being:
- frequent meals in small portions.
- exception hot and cold dishes.
- it shows low-fat broths and soups, porridge with diluted milk or water, compotes, fruit in shabby form, steamed vegetables.
- sharp, sour, salty, fatty and fried meat products are contraindicated; it is necessary to boil everything, cook in the form of mashed potatoes.
Strongly contraindicated alcohol, carbonated drinks, beer.
In order to prevent the transformation of healthy veins of the esophagus into pathological, varicose veins, it is first necessary to monitor the state of the liver and promptly treat all its diseases. To do this, experts advise to regularly contact them for advice and follow all the recommendations.
Prediction for life
Unfortunately, esophageal varicose veins are incurable. However, in the case of timely diagnosis, adequate supportive treatment will significantly improve the patient’s quality of life and help prevent a formidable condition - bleeding.
Mortality with already arisen bleeding from varicose veins of the esophagus is more than 50% and depends on the severity of the underlying disease and the condition of the body as a whole. Patients who survived bleeding in 75% of cases in the next 1-2 years relapse.
In general, the prognosis of long-term survival of patients with this disease remains low, which, mainly, is the cause of the underlying severe liver disease.