Varicose veins of the esophagus develops from the disruption of blood flow in the portal vein and upper hollow veins. There is such a pathology in the distal esophagus or proximal stomach. Character appearance can be congenital and acquired. The latter, moreover, does not depend on the age of the patient, and arising from the member, and barriers to the normal flow of blood in the portal vein.
Varicose esophagus veins accompanied by portal hypertension of various origins. This release:
- portal blockage of the blood flow in the kidneys;
- external blockages of the kidneys;
- the mixed form of blockage.
Varicose veins of the esophagus injuries in their youth are more often caused by a blockage of the liver in adults – the inner of the liver.
Causes of varicose veins of the esophagus
The causes of the disease, caused by the anatomical connection of the esophagus veins, the portal veins, veins of abdominal organs, mainly the spleen. Once the internal form of the blockage of blood flow, liver pathology covers the lower esophagus, the causes are peaceful processes in the portal vein of the liver, which occur when:
- in peritonitis.
This blockage of blood flow due to thrombosis of the portal vein, compression of her tumors, lymph nodes, cysts or stones in the bile ducts. Varicose veins in the upper part is also in the malignant goitre, or disease of the esophagus and the vascular changes with rare diseases.
More rarely the disease develops when the pressure in the systemic circulation, as is indicated in case of chronic cardiac insufficiency. A typical feature is that the vascular node in the liver disease is 2-3 times higher.
There is also a congenital form of varicose damage to the esophagus, the causes of which are unclear.
Symptoms of varicose veins of the esophagus
At the complicated outflow of blood from the esophageal veins in them begin to develop the extension, tortuosity and elongation. The walls of the veins and so become thinner and can rupture, which include the development of bleeding. The openings of the veins do not increase in a balanced way, the creation of a local extension in the form of nodes.
Development of the disease can quickly and may occur very slowly. Very often, the disease appeared within a few years, it may not be obvious itself. Patients worry about vague complaints, among them:
- a lot of weight in the chest;
- the occurrence of esophagitis.
Approximate age of patients is about 50 years old, men between the patients in two times more than women.
Development bleeding is the most serious complication of varicose veins of the esophagus. This can be observed to the patient and can pose a threat to his life. The main symptom is vomiting red blood. Not even the threat of the mind, which is quiet running, but the regular loss of blood can cause iron deficiency anemia.
The reason for such bleeding can be:
- increase in blood pressure;
- lifting weights;
- the heat of the situation.
Sometimes this bleeding may appear suddenly among full health, having a generous nature to cause death. Harbingers have a slight tickle in the throat, characterized by a salty taste in the mouth. Soon after their appearance suddenly vomiting scarlet or resembles coffee grounds blood. Sometimes the bleeding results in the implementation of the disease, suggesting the need for early detection of diseases.
Varicose veins of the esophagus and cirrhosis of the liver
Varicose veins of the esophagus can be observed in 70% of patients with liver cirrhosis. This phenomenon can be explained by the fact that in liver cirrhosis, the formation of scarring tissue, displacing healthy cells. This slows down blood flow and lead to blockages which are the cause for this pathology, the development of the lower part of the esophagus. Variceal bleeding are the cause of death with cirrhosis in 10-15% of cases. The most formidable diagnostic sign of early relapses.
For this reason, patients with cirrhosis should undergo periodic endoscopic examinations to detect varicose veins. In the absence of enlargement of esophageal veins, the frequency of such inspections should be once in 2 years, if there is one or 2 times a year. The frequency and level of detectable dilatation is usually proportional to the severity of the cirrhosis.
In the treatment of these patients is very important for the prevention of rebleeding. Based on the use of drugs that reduce portal pressure, endoscopic sclerotherapy and surgical techniques. It should be noted that relapse prevention is worse results from the prevention of the first episode of bleeding.
For diagnosis, the following studies:
- laboratory investigation;
- Ultrasound of the liver;
- x-ray examination.
The key is the procedure that gives you the opportunity to determine the cause of bleeding, to determine the status of the vein wall and the degree of dilatation of the veins, and to predict the rupture of another aneurysm. If bleeding has already started, the cause is difficult to determine due to the difficulty in conducting effective esophagoscopy.
Part of the information about the condition of the esophagus and of the nature of varicose veins can be obtained on the basis of radiography of the esophagus, which is performed with contrast.
As a condition of varicose veins usually associated with severe liver disease, it is important to assess the extent to which it is possible coagulopathy. If you want to do this, perform General blood tests, to determine platelet count and prothrombin index, and liver function tests. If the bleeding should have a blood group, RH factor and cross-test on the compatibility of erythrocyte mass.
In the differential diagnosis should exclude the possibility of many other diseases, such as:
- peptic ulcer disease;
- heart disease;
- hemorrhagic diathesis.
Treatment of varicose veins of the esophagus
Treatment of varicose veins of the esophagus, aiming to eliminate the disease, which has led to increased pressure in the portal vein and the Vena cava, as well as to address the threat of possible bleeding. Such measures also include the prevention of esophagitis, the gentle way of life, consumption of medications – antacids, vitamins, laxatives.
If there is a bleeding of the following measures:
- the introduction of a vasoconstrictor drug;
- compression of the vessels of the esophagus with special devices;
- the use of a specific probe for cryosurgery;
Compensation for the loss of blood ill do a transfusion, infusion of Packed red cells or plasma-replacement solution.
When massive bleeding is a more serious operation, which can significantly reduce mortality. It is noticed that the conservative treatment the mortality is 3-fold higher than surgical. The allocation of palliative and radical surgery to correct of the esophagus bleeding.
Endoscopic treatment methods
Currently there is considerable experience with the use of minimally invasive endoscopic procedures for the elimination of bleeding from enlarged esophageal veins.
Endoscopic sclerotherapy was first described 1939. Only in the 70-ies of the last century in connection with development and improvement of the endoscopic unit, began an intensive implementation of the method in practice. It used funds from a different mechanism of action.
To improve the results of sclerotherapy makes use of a balloon tamponade.
Good results, allowing the achievement of the endoscopic doping, which was proposed in 1985. Therefore, it is the shedding of the blood flow in varicose veins of the esophagus is performed with the use of alloy rings. Recurrence after surgery was only 17% of patients, which is almost twice less, than after hardening.
This method helps to stop the bleeding with compression of the bleeding site. This is very dangerous and should only be performed by an experienced technician. The main tool is a special probe equipped with the roller. Hemostasis is achieved by filling the stomach of the balloon and stretching, without the sect
Treatment of esophageal balloon. Because this is the tamponade varices, and decreases the amount of bleeding from the venous plexus. Filling of the esophageal balloon is performed very rarely, due to the risk of possible complications.
The effectiveness of the use of the balloon tamponade is 90%.
For the treatment of this disease used the following surgical techniques:
- a special system of bypass surgery in the liver (TIPS);
- bypass surgery;
Technique TIPS is to create intrahepatic artificial channel between the hepatic and portal veins, and install in the water, the metal of the stent. Thank you for this almost always fails to stop the bleeding, including those who are not amenable to other treatments. The main disadvantage of the method is its complex and requires the further development of liver encephalopathy.
The efficiency of the parallel close to the efficiency of the TIPS to a much higher trauma. The occurrence of liver encephalopathy is also a serious problem.
Some operations consist in the junction of the esophagus. This type of transaction effectively help stop bleeding, does not eliminate the causes of portal hypertension, which leads to rapid recurrence of the development of this disease.
The prognosis depends on the severity of the underlying liver disease. In General, varicose veins are characterized by a high mortality rate, exceeding 50%. Mortality is not determined by the severity of bleeding and the nature of the liver diseases that led to it.
Although 80% of patients stop bleeding on their own, even in this case primarily in patients with good liver functional status, but in patients with severe hepatocellular insufficiency, is often fatal.
The survivors after bleeding the patients in 75% of cases within 1-2 years is a repetition. Reduces the risk for these regular medical and endoscopic treatment of varicose veins.
In General, the prognosis for long-term survival of patients with this disease remains low, which in the main is the fault of the main severe liver disease.