Varicose veins of the esophagus: what is it and how to treat it? Auxiliary therapy with folk remedies. Treatment of varicose veins of the stomach and lower esophagus

Varicose veins of the stomach are a pathological condition characterized by the appearance of tortuosity and vascular sacs filled with blood. The disease develops against the background of severe chronic pathologies of internal organs. Symptoms are most often absent before the development of dangerous complications. For diagnostics, hardware methods are used. The disease is treated with surgical and conservative methods.

Causes and symptoms

With the development of varicose veins of the stomach, the causes may be the following:

Portal hypertension, characterized by increased pressure in the portal vein. Such a pathological condition is considered a complication of liver diseases (chronic viral hepatitis, cirrhosis and cancer, echinococcal cysts, benign tumors, tuberculous lesions).
Compression of the portal vein. In this case, there is a slowdown in the outflow of blood from the vessels of the stomach and esophagus. The venous walls lose their elasticity and remain in a stretched state. The risk of violation of the integrity of blood vessels increases. The portal vein is compressed by cysts, neoplasms, adhesions and stones that form in the gallbladder.
Increased pressure in the systemic circulation. Similar is observed in decompensated heart failure. The outflow of venous blood from the upper parts of the body is difficult, the gastric vessels expand, lengthen and become tortuous. Varicose nodes with thin walls are formed. The rupture of such a site is the main cause of the development of internal bleeding.
Congenital malformations of the structure of blood vessels. In the stomach, varicose veins can occur due to malfunctioning valves, causing backflow of blood.
Age-related changes in the body. The elasticity of the vascular walls decreases, due to which they become unable to contract normally. The blood stagnates, causing the veins to dilate.

The clinical picture of the disease includes:

Pain in the stomach. The vascular walls are located in the thickness of the mucous membranes, because of which, with varicose veins, the latter are often damaged and inflamed. This contributes to the appearance of unpleasant sensations that occur regardless of eating.
Heartburn, sour belching. They are the first signs of a violation of the functions of the stomach, caused by a deterioration in blood supply.
Swallowing problems. Occur with varicose veins of the upper sections of the stomach, bordering the esophagus. Large knots interfere with the normal passage of the food bolus, causing pain. With the formation of venous nodes, the appearance of a feeling of heaviness behind the sternum is also associated.
Internal bleeding. Accompanied by the release of vomit with bloody impurities, nausea, muscle weakness. Feces become black in color due to the presence of clotted blood. With massive bleeding, vomit has a bright red color, pronounced weakness is observed, consciousness is disturbed, sweating increases. The pressure drops, the heart rate rises.
Signs of anemia. With the frequent occurrence of minor bleeding, the hemoglobin level decreases, dizziness appears, accompanied by pallor of the skin and a decrease in efficiency.

How the disease is diagnosed

Varicose veins of the stomach are detected using the following procedures:

X-ray examination of the stomach. Helps to detect varicose veins on the surfaces of the walls of the stomach and lower esophagus.
Esophagogastroduodenoscopy. An endoscope equipped with a camera and a backlight is inserted into the stomach cavity. Through endoscopy, pathological changes are revealed, expressed in the appearance of nodular venous protrusions. With heavy bleeding, examination may be difficult. Endoscopy helps to make an accurate diagnosis, determine the stage of the disease and assess the risk of rupture of the venous wall.
Ultrasound of the abdominal organs. Examination of the liver helps to determine the disease that is the cause of varicose transformation of the gastric veins.
General blood test. It is an auxiliary method aimed at identifying an indirect sign of bleeding - a decrease in the level of hemoglobin and platelets.

Treatment Methods

It is completely impossible to cure the disease. Treatment of gastric varicose veins is aimed at stopping and preventing bleeding, preventing the formation of new nodes, and slowing down the development of pathological changes.

Medicines

The drug treatment regimen includes:

Vasopressin. The drug constricts the vessels responsible for the blood supply to the internal organs, helping to reduce pressure in the portal vein. It is administered intravenously.
Hemostatics (Etamzilat). Promote faster blood clotting, can be used to stop mild bleeding.
Proton pump inhibitors (omeprazole). Reduce the production of hydrochloric acid, preventing damage to the vascular walls.
Iron preparations (Ferrum Lek). Eliminate signs of anemia.

Surgical intervention

To stop bleeding and eliminate varicose veins, the following operations are used:

Banding. The section of the vessel located above the varicose vein is pulled together with a latex ring. In this way, the blood flow is blocked, as a result of which the bleeding stops and disappears.
Transconjugated intrahepatic shunting. During surgery, a hollow tube (stent) is inserted into the hepatic vein to connect the vessel to the portal venous system. The procedure is performed by inserting a catheter into the jugular vein. The operation reduces the pressure in the portal vein and normalizes the outflow of blood from the gastric vessels.
Splenorenal shunting. The splenic veins connect with the renal veins. This helps to reduce the volume of blood filling varicose vessels and stop bleeding.
Devascularization. During the operation, damaged bleeding veins are removed. The intervention is carried out when other methods are ineffective.

Folk remedies

For the treatment of the disease, the following folk recipes are used:

Sophora japonica tea. 1 st. l. Herbs are brewed in 1 cup boiling water. Tea is consumed during the day, dividing the resulting volume into 4 doses. You need to be treated for at least 2 months.
Infusion of mountain ash and wild rose. 2 tbsp. l. berries mixed in equal proportions are poured into 0.5 liters of hot water. The mixture is boiled over low heat for 5 minutes, left for 3 hours. The drink is drunk 100 ml before each meal.

Sclerotherapy

During the procedure, a chemical substance is injected into the expanded part of the vein, which glues the walls of the vessel. The flow of blood stops, disappears.

diet therapy

Patients with varicose veins of the stomach are prescribed a strict diet. Food is boiled or steamed and then ground with a blender. It is not recommended to eat solid food and swallow large pieces. Food should be at a comfortable temperature. Refuse hot and cold foods. Alcohol, rich pastries, strong tea, salty and pickled foods, sour fruits and berries are excluded from the diet.

Varicose veins of the esophagus: risk factors, symptoms, complications, treatment

It is unlikely that someone who does not have a medical education will say offhand what the disease "phlebectasia" means. But having heard the phrase "varicose veins", many will be able to understand what it is about. Simplified, this diagnosis sounds like varicose veins or varicose veins, which occurs both in older people and in young people. One of the forms of phlebectasia (from the Greek phlebos - vein and ektasis - stretching) is esophageal varicose veins.

Definition

Esophageal varicose veins are classified as a pathological process during which deformation (lesion) of the veins of the esophagus occurs: not balanced the lumen of the venous vessels increases in the form of highlighting their walls, nodes are formed(local extensions). These deformed veins become tortuous, and the thinned mucosa over them becomes prone to inflammation or damage. Varicose veins appear during an increase in pressure in the blood circulation system that includes the vessels, that is, in. This phenomenon accompanies the process of outflow of blood into, which is one of the largest veins in the human body. Its function is to collect venous blood from the lower body and deliver the blood flow to the right atrium, where it opens.

At the initial stage, varicose veins of the esophagus do not manifest themselves in any way, therefore, often a person with a similar disease is not even aware of the impending threat and may not complain to a doctor for a long period. Only when the veins, due to their fragility, begin to rupture and bleed, can one think of a disease. In addition, this bleeding is extremely dangerous for the life of a sick person.

Initial diseases

High pressure in the cavity of the portal vein, through which blood from the stomach, pancreas, spleen (digestive organs) passes to the liver, will be a factor causing esophageal varicose veins. The syndrome of pressure exceeding the permissible level in the portal vein system is called in medicine, which, as a rule, accompanies the following diseases:

Structural changes in the vessels of the liver and the organ as a whole (chronic hepatitis, cirrhosis, tuberculosis, tumors, amyloidosis);
Sclerosis;
Thrombosis;
Squeezing (narrowing of the lumen) of the portal vein: tumors of various sizes, including cysts, gallstones;

These diseases are defined as the main causes of varicose veins of the esophagus. In some cases, these primary sources of varicose veins are supplemented by another one - chronic, which causes an increase in pressure in the systemic circulation.

Depending on the pathology of the liver or the cardiovascular system, there are differences in the parameters of the affected veins:

If the cause of phlebectasia is liver disease, then the damaged veins are concentrated in the lower part of the esophagus or in the central part of the stomach; if the basis of the disease is a heart lesion, then the deformed veins are localized throughout the organ;
In liver diseases, vascular nodes are 2-3 times larger than in cardiovascular insufficiency.

There is also a congenital form of esophageal varicose veins, the causes of which have not been established.

The root cause is cirrhosis of the liver

As medical practice shows, esophageal varicose veins are found in 70% of patients with cirrhosis of the liver.

The principle of interaction is simple: in cirrhosis, instead of healthy cells, scar tissue forms on the liver. This impedes the movement of blood, congestion occurs in the system of the portal vein of the liver, which cause varicose veins in the lower (distal) zone of the esophagus. This chronic process is accompanied by a violation of the healthy structure of the liver.

In adults, the most common causes of cirrhosis are:

Frequent use of alcoholic beverages;
Viral hepatitis;
Taking medications that adversely affect the liver perenchyma;
Some hereditary diseases.

Cirrhosis of the liver in newborns, as a rule, is the result of viral infections (rubella, herpes, hepatitis) transferred by the mother during pregnancy, which, having penetrated the placenta, affected the fetus in utero.

Signs of illness

According to medical statistics, the conclusion suggests itself that phlebectasia of the esophagus occurs in men 2 times more often than in women. The average age of people diagnosed with this disease is 50 years. The course of the disease is individual in each case. The development of esophageal varicose veins can be rapid or slow. In the first case, those with this disease can remain ignorant for a long time, and only minor symptoms will help to understand that certain disorders are occurring in the body. These include:

heartburn;
belching;
Slight difficulty swallowing food;
Discomfort and heaviness in the chest;
Cardiopalmus.

The listed symptoms often act as harbingers of esophagitis - an inflammatory process of the esophageal mucosa, which accompanies varicose veins.

The most serious and extremely unsafe complication of varicose veins of the esophagus is bleeding. With repeated blood loss due to development, the general condition of the human body worsens, weakness, shortness of breath, pallor appear, and weight is lost.

Danger of bleeding

Bleeding from the veins of the esophagus can often be imperceptible to a person, or profuse (significant), which poses a threat to life. Its prerequisites may be:

Weight lifting;
Increased blood pressure;
Fever;
Binge eating;
Ordinary gastrointestinal diseases.

Before blood flows from damaged veins, a person may experience a slight tickling sensation in the throat and a salty taste in the mouth. After this, vomiting of blood is possible, the color of which ranges from scarlet to dark brown (the consistency and color of coffee grounds). Due to such blood loss, dizziness and darkening of the eyes are possible. without urgent medical intervention are fraught with death.

However, even in the case of minor blood loss, but with repeated repetition (a vessel burst in the esophagus), there is a threat of developing iron deficiency anemia, that is, there is a decrease in the concentration of iron, which is a constant component of heme in hemoglobin.

Diagnosis of the disease

It is possible to suspect varicose veins of the esophagus already during the initial examination by a therapist who, based on the anamnesis data, will prescribe laboratory and instrumental studies:

Disease history. An anamnesis in medicine is the totality of all the information obtained during the examination and questioning of the patient. Complaints of the patient about the current condition are listened to, it turns out whether the patient had previously suffered tumors, hepatitis. During a medical examination, the color of the skin and mucous membranes, the presence of edema are visually determined, palpation and percussion (percussion) are performed.
Laboratory research. The patient gives a general (with platelet count) blood test and biochemistry (liver enzymes, protein, albumin, serum iron, lipid spectrum). In some cases, there is a need for an in-depth study of the liver, since disorders occurring in it can cause rupture of the esophageal vein and additional blood tests (clotting and duration of bleeding, blood type according to the AB0 and Rhesus systems).
A number of instrumental studies (esophagoscopy, ultrasound, X-ray). These procedures are aimed at studying a specific area of \u200b\u200bthe esophagus and peritoneal organs.

Formulating the diagnosis, the disease-root cause is indicated first, and then - varicose veins of the esophagus. Complications, if any, must be listed at the conclusion of the examinations.

X-ray and esophagoscopy

It is possible to detect dilated veins of the esophagus and obtain information about the nature of the disease during x-rays. The image will show the jagged contours of the esophagus, the convoluted shape of the mucosal folds, and possibly the presence of serpentine-like accumulations.

The most detailed and reliable information can be obtained by performing fibroesophagoscopy (an internal examination of the surface of the esophagus). A damaged esophagus must be examined very carefully so as not to injure the fragile venous walls and not cause sudden bleeding. With the help of such a procedure, the causes of bleeding are identified, the degree of vein expansion and the condition of the venous walls are determined, whether there are extraesophageal bleeding factors, and a possible next rupture is predicted. It is often impossible to specifically establish the source of bleeding, because after the rupture the vessels subside, and the blood outlet is not determined.

In some cases, carrying out these two main studies helps to find the cause of bleeding: an ulcer, a collapsing tumor, Mallory-Weiss syndrome. The latter disease is accompanied by a rapid rupture of the mucous membrane of the lower esophagus, which can occur during vomiting.

Treatment Methods

The main goal of treatment for esophageal varices is to prevent bleeding.. However, if it does occur, then the first priority is to stop it and conduct therapy that prevents blood loss in the future.

Elimination of the threat of bleeding in the esophagus is possible if all efforts are directed to combat the disease that resulted in portal hypertension (, hepatitis, thrombosis). Drugs used to treat heart disease (such as beta-blockers) can lower blood pressure and therefore the risk of bleeding. Nitroglycerin may also be an assistant in case of its long-term use.

The main classification of non-surgical treatment procedures is aimed at preventing and eliminating bleeding (hemostatic therapy) by reducing pressure in the vessels:

In cases where the listed methods are not enough to completely stop the bleeding and there is a risk of repeated damage to the vessels in the near future, they resort to operations: endoscopic or surgical.

Endoscopic interventions

Since the determination of such a diagnosis as varicose veins of the esophagus becomes possible, first of all, due to the ongoing endoscopy, the treatment of the disease often involves endoscopic hemostasis. Commonly used endoscopic procedures include:

Electrocoagulation;
The introduction of a probe to compress the veins, holding a tight tamponade;
Doping of the veins of the esophagus;
Bandage;
Application of thrombin or a special-purpose adhesive film to the affected areas of the veins.

Electrocoagulation involves the removal of damaged vein tissue by electric current. Sometimes doctors recommend to patients a procedure that involves the establishment of a bandage - small rubber discs that are fixed over dilated vessels. This helps stop bleeding.

The use of a rubber probe, for example, Sengstaken-Blackmore, to act on damaged veins involves pressing a bleeding vessel. This happens by inflating two balloons of the probe, which are securely fixed in the cardia and squeeze the deformed veins. Modern corrugated probes are also used in the treatment of stomach ulcers. However, if this method does not give the required results, compression with plugging balloons through the esophagoscope is used.

In case of poor tolerance of surgical interventions by patients, for example, with cirrhosis of the liver, doctors use the method of minimally invasive intervention - endoscopic ligation of varicose veins of the esophagus. This method of treatment consists in ligation of damaged veins with small elastic rings (from 1 to 3 rings are superimposed on each dilated vein) or with nylon loops in order to achieve complete collapse of the veins, followed by their sclerosis.

Surgical operations

Video: varicose veins of the esophagus

The venous system is located in all parts of the human body, including the internal organs, where varicose veins can also develop. One of the most dangerous types of pathology is varicose veins of the stomach. Remaining virtually unnoticed until its advanced stages, the disease has internal bleeding as its most common complication, with a high mortality rate of 45%.

The main reason for the expansion of veins in the tissues of the stomach and lower esophagus is development of portal hypertension. Due to severe liver pathologies (hepatitis, cirrhosis, vascular anomalies), increased pressure occurs in the portal vein system. As a result, in an effort to lower it, the blood flow is redirected to the vessels of the stomach and esophagus. The veins of these organs are not designed to pump large volumes of blood, so their walls gradually become thinner and lose their elasticity - varicose veins develop.

Thrombus formation

Among the factors provoking the disease include:

cardiovascular insufficiency;
oncological pathologies;
hereditary predisposition.

Any disturbances in the functioning of the digestive organs can lead to deformation and expansion of the internal veins.

Symptoms and signs of the disease

In the initial stages, the disease may not manifest itself in any way, with the exception of heartburn or belching. Later, in the absence of adequate therapeutic measures, the signs of VRV of the esophagus and stomach will progress. Appear:

discomfort in the chest area;
difficulty swallowing;
deterioration in general health: weakness and chronic fatigue;
the appearance of blood impurities in the stool.

In the later stages of the pathology, more severe symptoms are observed:

frequent urge to vomit;
the presence of blood and mucus in the vomit;
failures in the work of the heart, accompanied by tachycardia;
the appearance of pain in the stomach and abdomen.

Varicose veins in the stomach may be accompanied by bloody vomiting - at this moment the patient needs urgent medical care.

How the disease is diagnosed

Depending on the severity of the symptoms, varicose veins of the stomach and esophagus are divided into several stages, the initial degrees of which can only be detected using hardware diagnostics:

Stage 1 - there are no signs of the disease, and ectasias (expansion) of the veins are observed in separate areas. In this case, diagnosis is possible only by endoscopic method;
Stage 2 - characterized by the absence of severe symptoms, however, with the help of endoscopy or x-rays, tortuous and unevenly swollen vessels can be detected. The swelling does not exceed 3-5 mm, and the narrowing is insignificant. At this stage, bleeding is rare;
Stage 3 - signs of the disease: a strong swelling of the veins (up to 10 mm) is combined with a significant narrowing of their lumen, while knots and weaves are determined. The chance of bleeding is increased;
Stage 4 - in parallel with the severity of protruding vessels and nodes, the venous walls become thinner, as well as the gastric mucosa. The risk of damage to them with any minimum effort increases many times over.

When diagnosing a disease, the following types of studies are used:

Ultrasound of the abdominal organs;
Blood, urine, stool tests;
Esophagogastroscopy - examination of the esophagus and stomach with an endoscope;
X-ray examination in combination with contrast (barium sulfate) to assess the conductivity of the alimentary tract.

According to individual indications the doctor may prescribe functional and hepatic examinations (for

division of coagulopathy - disorders in blood clotting).

Treatment Methods

The method of drug therapy or surgical intervention depends entirely on the stage of the disease, the general health of the patient and his individual indicators.