Varicose veins of the esophagus: causes, symptoms and methods of treatment.

Diseases of the veins and large blood vessels are accompanied by significant changes in their physical condition, which negatively affects the quality of the blood circulation process. And varicose veins of the esophagus, which can significantly reduce the patient's quality of life due to impaired quality of digestion and blood flow in the body, require an attentive attitude and timely initiation of treatment. This pathology can be accompanied by the addition of secondary lesions of the digestive organs, or it can occur and proceed independently.

However, with any kind of appearance, dilated veins of the esophagus and subsequent arising varicose veins are accompanied by unpleasant symptoms that make it possible to identify the lesion in question at the initial stage of development and to begin a therapeutic effect in a timely manner. prevent the development of complications. Medical statistics indicate that this pathology of the veins of the esophagus occurs predominantly in the male population (women are affected by varicose veins of the esophagus twice less than men), while the average age when the first varicose veins can be noticed manifestations of the disease is 50-55 years.

Causes of the appearance of the disease

The causes that cause the appearance of varices of the esophagus may be different depending on the manifestation of the disease, the general state of the patient's organism, in each case the set of causes may vary. However, in any case, varicose veins that occur in the veins of the digestive organs are the result of a change in the general condition of the veins. The reason for the manifestation of varicose veins of such localization is excessively high blood pressure in the venous circulation, which is most often characteristic of liver cirrhosis.

And the result of such an expansion can be massive bleeding, the danger of which lies in the absence of symptoms, which can be considered a warning: bleeding in esophageal varicose veins is often profuse, which is a real danger to the general condition. of the patient. Therefore, knowledge of the manifestation of this pathology of the veins of the esophagus and measures to prevent the disease will make it possible to diagnose it earlier and begin an adequate therapeutic effect.

Also, the following patient conditions may be the causes of this pathological change in the veins of the digestive organs:

• observed congestion in the portal vein;
• portal thrombosis;
• development of malignant goiter;
• esophageal angioma.

Likewise, the appearance of the lesion in question may be caused by the symptoms and vascular pathologies that accompany Randu-Osler disease. All these diseases and conditions are accompanied by negative changes in the circulatory system and digestive organs, which initially affects the general condition of the veins and large arteries of the esophagus and the tissues of the stomach. Changes in the circulatory system of internal organs such as the liver, spleen, and gallbladder can provoke the development of varicose changes in the esophagus.

The patient's symptoms

The main manifestation of a condition such as varices located in the esophagus is bleeding. This symptom can be noticed in the absence of warning manifestations, against the background of the so-called "full health". A sign of impending bleeding can be considered a slight tickling in the throat, a characteristic taste of blood when swallowing (salty-sour). The blood that forms during bleeding during the development of varicose veins is usually pronounced bright scarlet, it can resemble coffee grounds. The result of such bleeding, which is often prolonged and profuse, is dizziness, a feeling of weakness, loss of consciousness.

Since the causes of aggravation of varicose veins can be a variety of injuries to internal organs and the circulatory system as a whole, the overall quality of the functioning of these organs is largely determined by both the probability of developing varicose veins and for the symptoms they cause. may accompany this injury.

A symptom of the considered pathological change in the digestive organs can be considered bleeding, which develops during the asymptomatic course of the initial manifestations of the disease. Such bleeding can be insignificant, which does not immediately attract the patient's attention, or profuse, which has a high risk of death. Varicose veins, which are seen in the tissues of the esophagus and stomach, are most often characterized by the absence of significant changes that allow timely detection and treatment. However, this disease is one of the most formidable - with unexpected bleeding, which is characterized by a large amount of blood released, there is a high probability of death for the patient. According to medical statistics, out of five cases of manifestation and aggravation of varicose veins in the digestive organs, four are the death of the patient.

Types and degrees of varicose veins of the esophagus.

Today, experts distinguish several degrees of development of esophageal varicose veins, each of them has its own characteristics of development, differs in the list of manifestations and requires a certain therapeutic effect, which makes it possible to prevent further aggravation of varicose veins. pathology. Thanks to modern diagnostic methods, it is possible to determine the presence of the disease, its stage and degree of development.

There are the following degrees of expansion of the veins of the stomach and varicose veins:

• the first degree, in which there is a slight change in the lumen of the veins of the body. Varicose veins of the esophagus, characteristic of grade 1, may not be noticed by the patient, since he rarely has definite and pronounced symptoms. The veins of the esophagus have a lumen of 5 mm on average, which is not very different from their healthy state. However, even with this size, they become less elastic, since even small changes in their lumen lead to a decrease in the intensity of blood movement through them and the general quality of blood circulation in the affected organ is disturbed. Varicose veins of the first degree esophagus can be detected during a routine examination of this organ;
• the second degree is characterized by an increase in the lumen of the veins in the diseased organ up to 10 mm, the speed of blood flow through the veins gradually decreases, which negatively affects the condition of the veins - they continue to lose their elasticity, the walls gradually become thinner, which can cause bleeding due to the high probability of their rupture;
• at the third stage of aggravation of the pathology, there is an expansion of the lumen of the veins in the esophagus and stomach by more than 10 mm, the vessels, due to their expansion, are located close to each other, and even their slight trauma can cause bleeding. Often it is at the third stage of the development of the disease that heavy bleeding is observed, which causes the death of the patient, is a real danger to the life of a sick person suffering from varicose veins in the tissues of the digestive organs . .

The above classification of varicose veins of the esophagus allows us to classify the existing lesion of the veins of this organ to a certain extent and begin treatment, which has a positive effect on the patient's condition. Treatment of esophageal varicose veins should be chosen by a doctor who, based on studies and analyzes of the patient's general condition, chooses both the exposure scheme and the exposure variant, taking into account the characteristics of his organism.

Varicose veins of the stomach

The expansion of the veins, due to a negative change in their condition, can also be observed in the stomach. In this case, as in the case of esophageal varicose veins, there is a gradual decrease in the degree of elasticity of the walls of the veins, the appearance of a significant probability of bleeding. Modern diagnostic methods make it possible to detect the pathology in question in time and begin its treatment.

Methods for curing varicose veins, which are localized in the stomach tissues, differ, but all are aimed at eliminating the root cause of this condition. The National Chemistry Center of the Russian Academy of Medical Sciences provides such data on the causes and methods of treatment of varicose veins of both the esophagus and the stomach:

• treatment of manifestations of varicose veins in the esophagus and stomach according to the method described in the book of leading experts in gastroenterology, the differentiation of the identified disease of the digestive organ is carried out, and this technique and a detailed description From the manifestations of such rare lesions as pathologies of the operated esophagus, difficult-to-diagnose diseases of the digestive organs provide the greatest amount of information necessary to develop a scheme of therapeutic effects for both therapists and gastroenterologists;
• Zdenek Marzhatka, one of the most prominent specialists in the field of gastroenterology and diseases of the esophagus, accompanied by damage to the veins of its tissues, describes in detail in his writings various methods of diagnosing the disease, types of endoscopy of tissues of the stomach and esophagus.

Today, in order to prevent further aggravation of the existing pathology, more and more modern diagnostic methods are used, aimed at a more detailed study of the state of the tissues of the affected digestive organs.

Diagnosis of the disease

Methods and options for diagnosing varicose veins that have arisen in the digestive organs (esophagus and stomach) include the following diagnostic manipulations and procedures:

1. Fibroesophagoscopy, which allows you to identify the cause of bleeding. Also, this method allows you to determine the presence of mechanical causes for the appearance of bleeding, the state of the walls of the veins of the esophagus.
2. X-ray of the walls of the esophagus, which is more informative when using contrast.

Both options for diagnosing the disease in question have the ability to detect the cause of bleeding, determine the condition of the walls of the veins and the probability of rupture of existing aneurysms. The use of both diagnostic options allows, with maximum precision, not only to detect the pathology of the veins and vessels of the esophagus and stomach, but also to obtain the greatest amount of information available on the pathology.

Possible complications

Since varicose veins that occur in the tissues of the esophagus and stomach are especially dangerous due to the probability of bleeding, possible complications of this pathology should be taken into account. Significant damage to the digestive organs, aggravation of liver cirrhosis are the most dangerous consequences of this pathology of the veins.

treatment methods

The therapeutic effect to eliminate the risk of bleeding in case of damage to the veins of the esophagus and stomach should take into account the stage of the pathological process, the general health of the patient, the susceptibility of his body to the ongoing therapeutic effect. Modern medicine is constantly improving the methods of influencing the veins of the esophagus, which makes it possible to quickly eliminate the most obvious manifestations of the pathology in question.

Today, an integrated approach is used in the treatment of the considered pathology of the veins of the esophagus and stomach, consisting of a traditional, surgical and medical exposure method. Each method has its own characteristics, can be used for certain indications and is prescribed by a doctor. The course of treatment should be monitored at all stages by the attending physician, who, if necessary, will make the necessary adjustments in a timely manner and prevent possible risks of complications.

traditional method

First of all, when using the traditional treatment option for esophageal varicose veins, the bleeding, which can be fatal, is stopped. This will also allow additional methods of therapeutic action, which will ensure faster regeneration of damaged tissues and create the necessary scar at the site of injury to the esophageal vein.

To compensate for hypovolemia and prevent the occurrence of hemorrhagic shock, a significant (calculated by the doctor) dose of vitamin K is introduced into the patient's body, as well as infusions of frozen plasma (1-2 doses, intravenous transfusion is performed ) .

conservative method

With severe bleeding, which becomes a real danger to the patient's life, a rubber balloon can be used to quickly stop the bleeding. With the help of a probe, the bleeding vessel is pressed, which stops the movement of blood. For example, the probe of such a device - the Sengstaken-Blackmore probe - is popular for eliminating bleeding during the development of varicose veins in the digestive organs, in particular, the esophagus. Corrugated varieties of such probes are also used, which are widely used in the treatment of esophageal varicose veins with bleeding and bleeding gastric ulcers.

With the introduction of the probe under the site of the rupture of the vein, the esophagus can be washed with hot water at a temperature of 40 ° C; this measure often stops active bleeding and stabilizes the patient's condition. However, with repeated bleeding and at its high intensity, in parallel with the use of probes, it is recommended to carry out intravenous and intramuscular administration of substances that also contribute to stopping the blood. Calcium chloride 10-20 ml is administered intravenously. Do not use it for the introduction of drugs whose action is aimed at increasing blood pressure.

Treatment with an endoscope

Since this disease of the veins of the esophagus is most often diagnosed during endoscopic examination, endoscopic hemostasis may be prescribed to eliminate the most characteristic manifestations of the lesion (elimination of bleeding). This method involves sewing up the affected areas of the veins in the esophagus, and it is this variant of the therapeutic effect that is preferable compared to injection sclerotherapy due to the more pronounced positive dynamics of treatment.

Carrying out endoscopic treatment is characterized by a rapid interruption of bleeding, prevention of probable relapses of the disease. The drug, used in the application of endoscopic treatment of bleeding in varicose veins of the esophagus and stomach, is administered intravenously at 50 mcg, its action is aimed at increasing visceral vascular resistance, which allows stabilizing the patient's condition. , avoiding excessively active blood loss. . This drug is preferable to other drugs that can be given to stop venous bleeding from the esophagus because it has fewer side effects, even with long-term use.

The use of an endoscope involves the use of a special endoscopic examination of the esophagus, which is most often prescribed for bleeding, the cause of which is unclear. This technique is very popular due to the high efficiency of this diagnostic method and the good positive dynamics of treatment (ligation is performed), which is carried out using an endoscope. Endoscopic examination of the veins of the esophagus and stomach showed well at any stage of the development of the pathological process; In addition, this method makes it possible to detect even the initial manifestations of diseases of the digestive system in connection with blood circulation in the veins and to identify varicose veins of the esophagus.

The use of balloon tamponade.

The endoscopic method of exposure also involves the use of such a variant to stop bleeding from the veins of the esophagus, such as balloon tamponade. It consists in the impact on the site of damage to the vein of special obturation agents. However, with severe bleeding, balloon tamponade may not be very effective; additional drugs should be used to stimulate regenerative processes in the tissues of the walls of the veins.

The classification that is proposed today for the division of varicose veins of the esophagus and allows you to determine the most effective scheme of therapeutic effects. Taking into account the peculiarities of the stage of the current pathological process, the body's perception of the drugs used and the control of the ongoing treatment provide the attending physician with the opportunity to make timely adjustments and achieve the best results in stopping bleeding and stabilizing the the patient's condition.

Surgical intervention

Heavy bleeding, which is life threatening due to significant blood loss, may require surgery.

Surgical intervention may be prescribed for large blood losses, in which intravenous administration of plasma, blood, and blood-substituting fluids does not produce a pronounced positive result. There are several types of surgery for significant blood loss. Each of them is prescribed according to its indications determined by the doctor.

Today, the following types of surgical intervention are recognized as the most effective:

• imposition of a special bandage made of medical rubber. Such ligation of damaged veins allows you to quickly stop blood circulation, stop blood loss, which can cause a significant deterioration in the patient's condition;
• such an operation as bypass surgery leads to a decrease in blood pressure in the veins and, as a result, stops bleeding. During bypass, the liver tissue is affected, a special stent is inserted into the middle of this organ, which creates a kind of bridge between the liver tissues and the tissues of the esophagus, thereby reducing blood pressure. The hepatic and portal veins, which have such a "bridge", receive reduced pressure, which leads to the stoppage of bleeding;
• Splenorenal bypass is a type of bypass surgery that helps prevent possible bleeding when varicose veins are found in the tissues of the esophagus and stomach.

The listed options for surgical intervention allow you to eliminate the increase in blood pressure in the veins of the esophagus damaged by varicose veins. All of them are carried out under the control of X-rays and provide the greatest positive effect of manipulations to stop bleeding.

Medical treatment of varicose veins

There is also a variant of medicinal effects on the body to treat the initial stage of esophageal varicose veins. The choice of the type of drug is determined by the doctor after examining the patient's body, determining the stage of the current pathological process. When conducting this type of therapy, such indicators as the susceptibility of the patient's body to the drug used, the likelihood of developing allergic reactions, should be taken into account.

The most commonly used in the treatment of this disease are the following drugs with a pronounced effect on the veins:

The medications listed have a number of potential side effects that should be considered when prescribing them.

Treatment with folk remedies.

The reliability of drugs and methods of traditional medicine has been proven for centuries, but their effectiveness is not high enough to independently cope with the manifestations of varicose veins of the esophagus. Traditional medicine can be used as a maintenance drug, to increase the rate of recovery processes in the tissues of the veins. For example, with a high probability of bleeding, it is recommended to take decoctions and infusions of herbs that have a hemostatic effect. It can be collections of nettle, thyme, mountain bird.

Treatment with folk remedies is also possible at home, which is especially important for maintenance therapy of the disease, in the stage of remission. Since varicose veins of the esophagus is a serious injury, which poses a serious danger to the health and life of the patient, it is necessary to take into account the degree of impact of the selected traditional medicine. Home treatment is carried out under the constant supervision of a doctor.

Do you need a diet?

When diagnosing varicose veins in the digestive organs, the question of choosing a diet should be considered one of the most important, since both your well-being and the indicators of the ongoing therapeutic effect largely depend on the food that enters the patient's body. . The diet that is recommended for varicose veins of the esophagus involves the observance of several feasible rules, involving the exclusion of certain foods and the inclusion in the daily menu of certain products that heal the body in general and the esophagus in particular.

The diet for varicose veins of the esophagus should exclude the following foods and substances from the patient's diet:

• condiments;
• a large amount of table salt;
• excessive amounts of oils, especially of animal origin;
• fried, canned, and smoked foods, which irritate the tissues of the esophagus and can cause bleeding.

Nutrition for varicose veins of the tissues of the esophagus, as well as for cirrhosis of the liver, should include more boiled and stewed foods, fermented milk products will perfectly support the necessary microflora in the intestines, without creating an excessive load on the digestive system as an integer. Nutrition divided into small portions, control of the amount of calories to avoid excessive effects on the digestive system will prevent the aggravation of the existing pathology and maintain the health of the esophagus.

Disease prevention methods.

As a preventive measure for varicose veins, it is imperative to exclude bad habits, such as smoking, drinking alcoholic beverages, junk food, fast food.

Regular examinations by a gastroenterologist will help to identify the disease of the veins even at the initial stage of the development of the pathology and begin its treatment.

Healthy life style

Maintaining a healthy lifestyle should be mandatory for those looking to maintain a healthy digestive system.

Prevention of diseases of the veins, the use of vitamin preparations to maintain a high level of immunity, and examinations by a doctor are important components of success.

Physical exercise

To maintain the tone of the veins, to maintain the proper functioning of the digestive system, the necessary minimum of physical exercise should be performed regularly.

Walking, light jogging, exercise therapy exercises can be considered good preventive measures in the development of varicose veins.