Varicose veins of the esophagus — term venous extension in the lower part of the esophagus, which is the result of disorders of the blood circulation in the portal vein and, therefore, the gastro-esophageal plexus excessive amount flows the blood, that is in search of a reflux of the heart.
Due to the fact that the varicose veins of the esophagus in 90% of cases, corresponds to the cirrhosis of the liver, may appear yellowing of the skin and eyes, loss of appetite, decrease of body mass, ascites, abdominal pain, and nausea.
The most dangerous symptom of this disease is associated with hemoptysis, mixed with the blood vomiting, tarry a chair and a weakness.
Varicose veins of the esophagus in its sub-division occurs because of the stagnation in the system of the portal vein of the liver, which appear at the thrombosis and cirrhosis of the liver. The cause of this disease in the the top of is malignant goiter. The veins of the liver is compressed, which makes the current of the blood on him hard. Phlebectasia of the esophagus will also appear as a complication of diseases of the heart and of the spleen.
The factors of this disease:
- the stenosis of the portal vein, which is characteristic for the young generation, resulting from a thrombosis, multiple sclerosis;
- diseases of the liver occurring at an advanced age cirrhosis, amyloidosis, echinococcosis;
- disease Chiari malformation;
- angioma of the esophagus;
- of vascular pathology.
Varicose veins of the esophagus occurs most often in the categories of patients:
- in men;
- in people over the age of 50;
- in patients with a history of disease of the pancreas, the stomach, the heart, the chronic of the cirrhosis.
On the occurrence of bleeding does not affect both the level of the pressure, how sudden changes. The risk of rupture is high and in patients who suffer from vascular disease, have negative effects on the structure of the wall of blood vessels.
The classification of the disease of varicose veins of the esophagus has changed several times, however, it now uses the version of 1997 for the varicose veins of the esophagus, the separation of the disease into degrees:
- The first degree. The vein diameter reaches 5 mm, considerably strained, is located at a lower level of authority.
- The second-degree. Vienna convoluted, reach a diameter of 10 mm, located in the central part of the body.
- Of the third degree. The dilated vessels of more than 10 mm, the walls are stretched, thin, are located in close proximity, twists of direction, have red spots on the outer surface.
If the varicose veins of the esophagus, all the same, caused internal bleeding, according to the statistics, after him, survive only 50% of patients. More than half of survivors after hemorrhage, patients faced in a time of 1 to 3 years, with a recurrence of this disease and the need again to start the treatment.
Varicose veins 1 degree
The clinical picture is expressed weakly. The patient has practically no complaints. During the follow-up survey: varicose veins is not strong, up to 3 mm, ectasias veins not, or only in isolated instances, the clearance is not completed. Are diagnosed using endoscopy. During the first measurement, it is important to as quickly as possible to begin treatment.
Varicose veins 2 degree
Well considering the roughness of the blood vessels, there are also nodules of size greater than 3 mm. When the lining of the esophagus remains in integrity, without any violation of its integrity.
At the completion of a study to diagnose a large rough of the blood vessels. The treatment must be conducted in a timely manner, only if you can get rid of bad symptoms of the disease at an early stage. The bleeding is not at this stage.
Varicose veins 3 degrees
The more often meet the diagnosis. In the patient of the symptoms to very severe. Generally, in this case, by surgery. The veins greatly swollen, the nodes clearly show through, constantly being improved, occupy the 2/3 of the esophagus, the lining of the esophagus strongly, thinning. You experience gastro-reflux.
Varicose veins 4 degree
This degree of the disease is identified, when in the esophagus are identified with numerous nodules of veins, not the fall, and weakened the surface. On the mucous layer are several erosion. Patients record, with the exception of signs of esophagitis, the salty bitter taste in the mouth. The fourth degree is the most often leads to the spontaneously born from the bleeding.
The symptoms of varicose veins of the esophagus
The first few years, the varicose veins of the esophagus can occur without visible symptoms. Sometimes there are rare attacks of acid reflux, weakness, heaviness in the chest, belching. Some patients complain of difficulty swallowing food.
The symptoms of an aggravation of the disease usually occur a few days before the start of the bleeding. The signs are a strong heaviness in the chest, and poor overall health 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 in the form of the "head of medusa". This is a drawing that is quite well visible on the front of the abdominal wall with several pathologically formed convex, vessels or veins.
After the vienna tear, occurs as a heavy bleeding, with symptoms features:
- greatly reduces blood pressure;
- identify impurities and vomiting;
- identify impurities in masses of fecal;
- expressed tachycardia.
During the small bleeding the person may feel some weakness, discomfort, as well as the symptoms of anemia. Diagnose varicose veins of the esophagus with the aid of laboratory tests, ultrasound of organs of the abdominal cavity, if necessary, conduct x-ray and esophagoscopy.
The diagnosis is billed on the basis of complaints, the external inspection, the identification of the major diseases. The tool of research include:
- the data of laboratory analyses of blood;
- x-ray with contrast medium;
- esophagoscopy that you should pass carefully because of the risk of bleeding possible.
When the diagnosis of all possible causes must be taken into account and the excluded, that we will be able to definitively and detect the source of bleeding and to alter the veins of the esophagus.
The treatment of varicose veins of the esophagus
If you are experiencing symptoms of varicose veins of the esophagus, the treatment is only performed in the department of resuscitation or intensive care. The basic classification of nonsurgical procedures intended to prevent and solve the bleeding (hemostatic therapy) in lowering the pressure in the vessels:
- The drug treatment in the form of taking vitamins, the knitting of the drugs, and antacids (drugs that reduce the acidity in the stomach). This method aims at the prevention of esophagitis peptic, in which inflammation can occur on the walls of the blood vessels, causing bleeding.
- The transfusion of blood, the red blood cell mass, plasma;
- The introduction of solutions, colloidal;
- The reception hemostatic, and promotion of the contraction of the vessels of drugs.
In the case, if these methods do not suffice to carry the bleeding to stop and there is the risk of recurrence of a vascular injury in a near future, the use of surgery:
- transjugular intrahepatic portosystemic bypass (TIPS);
- bypass surgery;
Also, there currently exists considerable experience of using minimally invasive endoscopic procedure to resolve the bleeding of the esophageal veins. There are 2 ways to proceed with endoscopic sclerosing of the esophagus:
intranasally method of administration of sclerosant provides for the development of the connective tissue of the place of location of thrombosed varicose veins site. When the paravasal method, when the sclerosant is injected in submucous layer, is the healing paravasal fibers and compaction of the subsequent of varicose veins of the esophagus. This method is more gentle and has a smaller amount of complications.
Patients have need of all life to adhere to a strict diet, despite a state of health:
- the food in frequent small portions.
- the exclusion of hot and cold dishes.
- show low-fat broths and soups, cereals, multiplied on the milk or water, compotes, fruit in a dingy, cooked vegetables.
- against-sharp, sour, salty, fatty, and fried meat by products; it is necessary to all the boil, cook to a purée.
Absolutely contraindicated in alcohol, soft drinks, beer.
To prevent the healthy veins of the esophagus in pathological varicose veins in the first place, it is necessary to monitor the condition of the liver in a timely manner and treat all his diseases. To do this, experts advise regularly call on them for advice and recommendations.
Forecast for the life
Unfortunately, the varicose veins of the esophagus in the terminal phase. However, in the case of a diagnosis in a timely manner adequate to support the treatment is primarily to improve the patient's quality of life and help prevent the bad state of the bleeding.
The rate of mortality during the already referred to bleeding from varicose veins of the esophagus is more than 50 % and depends on the severity of the underlying disease and the state of the body in general. In survivors after hemorrhage, patients in 75% of cases in the next 1-2 years, there has been a recurrence.
In general, the long-term prognosis of patients with this disease remains low, which, primarily, serves as the fault fundamental of the serious liver disease.