Diseases of veins and large blood vessels are accompanied by significant changes in their physical condition, which negatively affects the quality of the process of blood circulation. And varicose veins of the esophagus, which can significantly reduce the patient's quality of life due to the deterioration of the quality of digestion and blood flow in the body, require a careful attitude and timely initiation of treatment. This pathology can be accompanied by the addition of secondary lesions of the digestive organs, or it can arise and proceed independently.
However, regardless of the type of appearance, the dilated veins of the esophagus and the resulting varicose veins are accompanied by unpleasant symptoms that make it possible to identify the lesion in question at the initial stage of development and trigger a therapeutic effectin a timely manner, prevent the development of complications. Medical statistics note 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 as rarely as men), while the average age at which the first manifestationsof the disease can be seen is 50-55 years old.
Causes of the onset of the disease
The causes that provoke the appearance of varicose veins of the esophagus can be different depending on the manifestation of the disease, the general condition of the patient's body, in each case the set of causes may vary. However, in any case, the varicose veins that appear 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 cirrhosis of the liver.
And the result of such expansion can be massive bleeding, the danger of which lies in the absence of symptoms, which can be taken as a warning: bleeding in esophageal varices is often abundant, representing a real danger to thegeneral condition of the patient. Therefore, knowledge of the manifestation of this pathology of the veins of the esophagus and measures for the prevention of the disease will allow to diagnose it earlier and begin an adequate therapeutic effect.
In addition, the following conditions of the patient can cause this pathological change in the veins of the digestive organs:
- congestion observed in the portal vein;
- portal thrombosis;
- development of malignant goiter;
- esophageal angioma.
In addition, the occurrence of the lesion in question can 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 affect the general condition of the veins and large arteries of the esophagus and stomach tissues. Changes in the circulatory system of internal organs such as the liver, spleen and gallbladder can cause the development of varicose changes in the esophagus.
Patient symptoms
The main manifestation of such a condition as varicose veins located in the esophagus is bleeding. This symptom can be noted in the absence of warning manifestations, against the background of the so-called "full health". A sign of impending bleeding can be seen as a slight tickling in the throat, a characteristic taste of blood when swallowing (salty acid). The blood that forms during bleeding during the development of varicose veins is usually pronounced as a bright scarlet, may resemble coffee grounds. The result of such bleeding, often prolonged and heavy, is dizziness, a feeling of weakness, loss of consciousness.
Since the reasons for the aggravation of varicose veins can be various damage to internal organs and the circulatory system as a whole, the overall quality of the functioning of these organs is largely determined both by the likelihood of developing varicose veins and by thesymptoms. may accompany this lesion.
A symptom of the considered pathological change in the digestive system can be considered bleeding, which develops during the asymptomatic course of the initial manifestations of the disease. Such bleeding can be both insignificant, which does not immediately attract the patient's attention, and heavy, which carries a high risk of death. Varicose veins, which are noted in the tissues of the esophagus and stomach, are most often characterized by the absence of any significant changes that allow them to be identified in a timely manner and to start treatment. However, this disease is one of the most formidable: with unexpected bleeding, which is characterized by an abundance of secreted blood, there is a high probability of death for the patient. As medical statistics indicate, 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 varices, each of them has its own characteristics of development, differs in the list of manifestations and requires a certain therapeutic effect, which allows to avoid further aggravation of thepathology. Thanks to modern diagnostic methods, it becomes 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, at which there is a slight change in the lumen of the veins of the body. Esophageal varices, characteristic of grade 1, may not be noticed by the patient, as they rarely present with definite and pronounced symptoms. The veins of the esophagus have an average lumen of 5 mm, which is not much different from their healthy state. However, even at this size they become less elastic, since even slight changes in their lumen lead to some decrease in the intensity of blood movement through them, and the overall quality of blood circulation in the affected organ is disturbed. Varicose veins of the esophagus of the 1st degree 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 in the veins gradually decreases, which negatively affects the condition of the veins: they continue to lose theirelasticity, the walls gradually thin, 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 otherothers, and even their slight trauma can cause bleeding. Often, it is at the third stage of the development of the disease that profuse bleeding is noted, which leads to the death of the patient, is a real danger to the life of a patient 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 start treatment, which has a positive effect on the patient's condition. The treatment of esophageal varices should be selected by a doctor who, based on the studies and analysis of the general condition of the patient, chooses both the exposure scheme and the exposure variant, taking into accountcharacteristics of his body.
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, just as in the case of esophageal varices, there is a gradual decrease in the degree of elasticity of the walls of the veins, the appearance of a significant risk of bleeding. Modern diagnostic methods make it possible to detect the pathology in question in time and begin its treatment.
Methods of healing varicose veins, which are localized in the tissues of the stomach, differ, but all of them are aimed at eliminating the root cause of this condition. The National Chemical Center of the Russian Academy of Medical Sciences provides such data on the causes and methods of treatment of varicose veins of the esophagus and stomach:
- treatment of manifestations of varicose veins in the esophagus and stomach according to the method described in the book of the best experts in gastroenterology, the differentiation of the identified disease of the digestive organ is carried out, and this technique and a detailed description of themanifestations of such rare lesions as pathologies of the operated esophagus, difficult-to-diagnose diseases of the digestive organs give the greatest amount of information necessary for drawing up a scheme of therapeutic effects for therapists andnarrow specialists-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 in its tissues, in his writings describes in detail various methods of diagnosing the disease, types of endoscopy of tissues of the stomach and esophagus.
Today, in order to avoid further aggravation of the existing pathology, more and more modern diagnostic methods are used, aimed at a more detailed study of the condition 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 manipulations and diagnostic procedures:
- Fibro-esophagoscopy, which identifies the cause of the bleeding. Also, this method allows you to determine the presence of mechanical causes that caused bleeding, the condition of the walls of the veins of the esophagus.
- X-ray of the walls of the esophagus, more informative when using contrast.
Both diagnostic options for the disease in question have the ability to detect the cause of bleeding, determine the condition of the walls of the veins and the likelihood of rupture of existing aneurysms. The use of both diagnostic options allows, with maximum accuracy, not only to detect the pathology of the veins and vessels of the esophagus and stomach, but also to obtain the greatest amount of available information aboutthe pathology.
Possible complications
Since varicose veins that occur in the tissues of the esophagus and stomach are especially dangerous due to the risk of bleeding, possible complications of this pathology should be taken into account. Significant damage to the digestive organs, aggravation of cirrhosis of the liver 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 state of health of the patient, the sensitivity of his bodyto 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, which consists of a traditional, surgical and medical method of exposure. 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 probable risks of complications.
traditional method
First, when using the traditional treatment option for esophageal varices, the bleeding is stopped, which can be fatal. It will also allow additional methods of therapeutic action, which will provide faster regeneration of damaged tissues and create the necessary scar at the site of damage to the esophageal vein.
In order to compensate for hypovolemia and prevent the occurrence of hemorrhagic shock, a large (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, an intravenous transfusion is performed).
Conservative method
In case of severe bleeding, which becomes a real danger to the patient's life, a rubber balloon can be used to quickly stop the bleeding. Using a probe, the bleeding vessel is squeezed, 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 varices 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 warm 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, along with the use of probes, it is recommended to carry out intravenous and intramuscular administration of substances that also help to stop the blood. Calcium chloride 10-20 ml is administered intravenously. Do not use 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 an endoscopic examination, endoscopic hemostasis can be prescribed to eliminate the most characteristic manifestations of the lesion (elimination of bleeding). This method consists in stitching the affected areas of the veins of the esophagus, and it is this variant of the therapeutic effect that is preferable in comparison with injection sclerotherapy due to the more pronounced positive dynamics of treatment.
Carrying out endoscopic treatment is marked by a rapid cessation of bleeding, the prevention of probable relapses of the disease. The drug, used in the implementation of endoscopic treatment of bleeding in the varices of the esophagus and stomach, is administered intravenously in 50 mcg, its action is aimed at increasing visceral vascular resistance, which allows tostabilize the patient's condition, avoiding excessively active blood loss . This drug is preferred over 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 not clear. This technique is very popular due to the high efficiency of this diagnostic method and the good positive dynamics of treatment (ligation is performed), carried out using an endoscope. Endoscopic examination of the veins of the esophagus and stomach showed itself 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 exposure method also involves the use of such a variant of stopping bleeding from the veins of the esophagus, as balloon tamponade. It consists in the impact on the site of damage to the vein of special clogging agents. However, in severe bleeding, balloon tamponade may not be very effective; additional drugs should be used to stimulate regenerative processes in the tissues of the vein walls.
The classification proposed today for the division of varices of the esophagus allows you to determine the most effective scheme of therapeutic effects. Given 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 bleedingand stabilize the patient's condition.
Surgical intervention
Heavy bleeding, which threatens the patient's life due to severe blood loss, may require surgical intervention.
Surgical intervention can be prescribed for severe blood loss, in which the intravenous administration of plasma, blood and blood substitute fluids does not bring a pronounced positive result. There are several types of surgery for severe 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 medical rubber bandage. Such ligation of damaged veins allows you to quickly stop blood circulation, stop blood loss, which can lead to a significant deterioration in the patient's condition;
- performing an operation such as a coronary bypass leads to a decrease in blood pressure in the veins and, therefore, to the cessation of bleeding. When performing a bypass, the effect on the liver tissue is realized, a special stent is inserted in the middle of this organ, which creates a kind of bridge between the liver tissue and the esophageal tissue, which lowers thearterial pressure. The hepatic and portal veins, having such a "bridge", receive reduced pressure, which leads to a stoppage of bleeding;
- Spleno-renal bypass is a type of bypass surgery, with the help of which the prevention of possible bleeding is carried out when varicose veins are detected in the tissues of the esophagus and stomach.
The options listed for surgical intervention can eliminate the increased blood pressure in the veins of the esophagus damaged by varicose veins. All of them are carried out under the control of x-ray beams and provide the greatest positive effect of manipulations to stop bleeding.
Medical treatment of varicose veins
There is also a variant of the drug effect on the body in order to treat the initial stage of varicose veins of the esophagus. The choice of the type of drug is determined by the doctor after conducting a study of the patient's body, determining the stage of the current pathological process. When carrying out this type of therapy, indicators such as the sensitivity 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 drugs listed have a number of possible side effects that should be taken into account when prescribing them.
Treatment with folk remedies
The reliability of drugs and methods of traditional medicine have been tested 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 the maintenance treatment of the disease, at the stage of remission. Since varicose veins of the esophagus are a serious lesion, 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 it is on the food entering the patient's body that his well-being andindicators of the ongoing therapeutic effect largely depend on . The recommended diet for varicose veins of the esophagus involves the observance of several feasible rules, which involve the exclusion of certain foods and the inclusion in the daily menu of certain products that heal the body as a whole and the esophagus as a whole. particular.
The diet for esophageal varices should exclude the following foods and substances from the patient's diet:
- seasonings;
- a large amount of table salt;
- excessive amounts of oils, especially of animal origin;
- fried, canned, smoked foods that 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 baked foods, fermented milk products will perfectly support the necessary microflora in the intestines, without creating an excessive load on thedigestive system as a whole. Fractional nutrition in small portions, control of the number of calories to avoid excessive effects on the digestive system will prevent 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, including smoking, drinking alcoholic beverages, junk food, fast food.
Regular examinations by a gastroenterologist will help to identify venous disease even at the initial stage of the development of pathology and begin its treatment.
Healthy lifestyle
Maintaining a healthy lifestyle should be mandatory for those looking to maintain a healthy digestive system.
The prevention of venous diseases, the use of vitamin preparations to maintain a high level of immunity, and examinations by a doctor are important elements of success.
Physical exercise
To maintain the tone of the veins, to maintain the proper functioning of the digestive system, you must regularly perform the minimum necessary physical exercise.
Walking, light jogging, exercise therapy exercises can be considered good preventive measures in the development of varicose veins.