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Varicose veins of the esophagus

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Varicose veins of the esophagus Varicose veins of the esophagus develops due to violation of the outflow of blood in the portal and superior vena cava. There is such a pathology in the distal esophagus or proximal stomach. By the nature of the appearance can be congenital and acquired. The latter, moreover, does not depend on the age of the patient, but on the arising state and obstacles to normal blood flow in the portal vein system.

Varicose esophageal veins are accompanied by portal hypertension of various origins. At the same time allocate:

  • intrahepatic portal blood flow blockade;
  • extrahepatic blockade;
  • mixed blockade.

Varicose veins of the esophagus at a young age are more often caused by extrahepatic blockade, in adults - intrahepatic.



Causes of esophageal varicose veins

The causes of the disease are caused by the anatomical connection of the veins of the esophagus with the portal vein system, the veins of the abdominal organs, especially the spleen. When intrahepatic form of blockage of blood flow pathology covers the lower parts of the esophagus, the causes of this are stagnant processes in the portal vein of the liver, which occur when:

  • cirrhosis;
  • thrombosis;
  • hepatitis;
  • tumors;
  • angiomas;
  • splenomegaly;
  • peritonitis.

Extrahepatic blood flow blockade is explained by thrombosis of the portal vein, squeezing it with tumors, lymph nodes, cysts or stones in the bile ducts. Varicose veins in the upper sections can also occur with malignant goiter or angiomegia of the esophagus, as well as vascular changes in the disease Randy-Osler.

More rarely, the disease develops with an increase in pressure in the systemic circulation, which is noted in the case of chronic cardiovascular insufficiency. A typical symptom is that the vascular nodes in liver diseases are 2-3 times larger.

There is also a congenital form of varicose lesions of the esophagus, the causes of which have not been elucidated.

Symptoms of varicose veins of the esophagus

With difficulty in the outflow of blood from the veins of the esophagus, they begin to develop expansion, tortuosity and lengthening. At the same time, the walls of the vessels become thinner and can rupture, which leads to the development of bleeding. Venous lumens do not increase in a balanced manner, local expansion in the form of nodes is formed.

The evolution of the disease can be rapid, and can proceed extremely slowly. Very often, a disease that has appeared for several years may not manifest itself. The patient is concerned about only some vague complaints, among them:

  • heaviness in the chest;
  • belching;
  • heartburn;
  • phenomena of esophagitis.

The approximate age of patients is about 50 years, among men patients are two times more than women.

Complications

The development of bleeding is the most terrible complication of esophageal varicose veins. It can pass unnoticed by the patient, and may pose a threat to his life. The main symptom is red blood vomiting. Even not seemingly dangerous, imperceptibly flowing, but regular blood loss can cause iron deficiency anemia.

The cause of the development of such bleeding can be:

  • straining;
  • rise in blood pressure;
  • weight lifting;
  • feverish conditions.

Sometimes such bleeding can occur suddenly in the midst of full health and, having assumed abundant character, lead to death. Its forerunners are a slight tickling in the throat, a characteristic salty taste in the mouth. Shortly after their appearance, vomiting of scarlet or blood that resembles coffee grounds unexpectedly arises. Sometimes the execution of fibroesophagoscopy leads to bleeding, which indicates the need for the earliest possible diagnosis of the disease.

Varicose veins and cirrhosis

Varicose veins of the esophagus can be observed in 70% of patients with cirrhosis of the liver. Such a phenomenon is explained by the fact that with cirrhosis, the formation of cicatricial tissue occurs in the liver, displacing healthy cells. This slows down the movement of blood and causes stagnation, which cause the development of this pathology in the lower esophagus. Varicose bleeding causes death to cirrhosis in 10-15% of cases. The most formidable diagnostic sign is early relapses.

For this reason, patients with cirrhosis of the liver should undergo regular endoscopic examinations for the detection of varicose veins. In the absence of expansion of the esophageal veins, the frequency of such examinations should be once every 2 years, and if so, once or twice a year. The frequency and degree of detectable varicose veins is usually proportional to the severity of cirrhosis.

In the treatment of such patients, great importance is attached to the prevention of recurrent bleeding. It is based on the use of drugs that lower portal pressure, endoscopic sclerotherapy and surgical techniques. It should be noted that prevention of relapse has worse results than prevention of the first bleeding episode.

Diagnostics

The following types of studies are used for diagnosis:

  • lab tests;
  • Liver ultrasound;
  • esophagoscopy;
  • x-ray examinations.

The main thing here is the implementation of fibroesophagoscopy, which makes it possible to establish the causes of bleeding, determine the condition of the venous walls and the degree of dilatation of the veins, as well as predict the rupture of another aneurysm. If the bleeding has already begun, its cause can be difficult to determine due to difficulties in performing effective esophagoscopy.

Some information about the status of the esophagus and the nature of varicose veins can be obtained on the basis of x-ray examination of the esophagus, performed with contrast.

Since the condition of varicose veins is usually associated with severe liver disease, it is important to assess the degree of possible coagulopathy. To do this, perform general blood tests with the determination of platelets and prothrombin index, as well as liver function tests. In the presence of bleeding, blood group, Rh factor and cross-test for red blood cell compatibility should be determined.

With differential diagnosis, it is necessary to exclude the possibility of many other diseases, such as:

  • peptic ulcer disease;
  • crayfish;
  • polyposis;
  • hernia;
  • heart disease;
  • hemorrhagic diathesis.

Treatment of varicose veins of the esophagus

Treatment of varicose veins of the esophagus is aimed at eliminating diseases that led to an increase in pressure in the portal and vena cava systems, as well as at eliminating the threat of possible bleeding. Such measures also include the prevention of esophagitis, a gentle way of life, taking medications - antacids, vitamins, laxatives.

If bleeding occurs, the following measures are taken:

  • the introduction of vasoconstrictor drugs;
  • squeezing of the vessels of the esophagus plugging devices;
  • use of a special probe for cryotherapy;
  • electrocoagulation.

To compensate for the loss of blood, patients undergo blood transfusion, erythrocyte mass infusion or plasma substituting solutions.

With massive bleeding, more serious surgical intervention is necessary, which can significantly reduce mortality. It has been observed that with conservative treatment, mortality is 3 times higher than surgery. There are palliative and radical surgeries to eliminate esophageal bleeding.

Endoscopic treatment methods

Currently, there is considerable experience in the use of minimally invasive endoscopic interventions to eliminate bleeding from the dilated esophageal veins.

Endoscopic sclerotherapy was first described in 1939. Only in the 70s of the last century, in connection with the development and improvement of endoscopic devices, the intensive introduction of the method into practice began. During it, sclerosants are used with a different mechanism of action. There are 2 ways to carry out endoscopic sclerosis of the esophagus:

  • intravasal;
  • parabasal

The intravasal method of introducing the sclerosing agent involves the development of connective tissue at the site of localization of the thrombosed varicose node. In recent years, most researchers refuse to conduct it, because it has a significant number of serious complications. Among them, esophageal perforation, necrotic and purulent thrombophlebitis .

With the paravasal method, when the sclerosant is injected into the submucous layer, the paravasal fiber is scarred and the esophagus is then squeezed. This method is considered more benign and has fewer complications.

The use of balloon tamponade helps to improve the results of sclerotherapy.

Good results can be achieved by the method of endoscopic doping, which was proposed in 1985. Accordingly, the cessation of blood flow in the dilated veins of the esophagus is performed with the help of alloying rings. Recurrences after such an intervention were observed only in 17% of patients, which is almost half as much as after hardening.

Balloon tamponade

This method helps to stop bleeding by squeezing the bleeding node. It is dangerous enough and should only be performed by an experienced technician. The main tool is a special probe equipped with a balloon. Stopping bleeding is achieved by inflating the gastric balloon and traction without inflating the esophageal balloon. Due to this, the tamponade of varicose veins is produced and the intensity of bleeding from the venous plexus is reduced. Inflating the esophageal balloon is performed very rarely, due to the risk of possible complications.

The effectiveness of the use of balloon tamponade is 90%.

Surgical treatments

The following surgical methods are used to treat this disease:

  • transjugular intrahepatic portosystemic shunting (TIPS);
  • shunting;
  • devascularization.

The TIPS technique consists in creating an intrahepatic artificial canal between the hepatic and portal veins and installing a metal stent in its ducts. Thanks to it, it is almost always possible to stop the bleeding, including that which is not amenable to other types of therapy. The main drawback of the technique is its high complexity and the mandatory subsequent development of hepatic encephalopathy.

The efficiency of shunting is close to the efficiency of TIPS with much greater morbidity. The occurrence of hepatic encephalopathy is also a serious problem.

Devascularization operations consist in the intersection of the esophagus and the subsequent imposition of anastomosis. A variety are the intersection of the esophagus with splenectomy and ligation of periesophagal and perigastric veins. Such operations effectively help to stop the bleeding, without eliminating the causes of portal hypertension, which leads to a rapid recurrence of the development of this pathology.

Forecast

The prognosis is determined by the severity of the underlying liver disease. In general, varicose veins are characterized by high mortality, which exceeds 50%. Mortality is not determined by the severity of the bleeding, but by the nature of the liver disease that led to it.

Although in 80% of patients the bleeding stops independently, it is mostly the patients who are distinguished by a good functional condition of the liver, but they are often fatal for patients with severe hepatocellular insufficiency.

Patients who survived bleeding in 75% of cases in the next 1-2 years relapse. Regular medical and endoscopic treatment of varicose veins reduces the risk of this.

In general, the prognosis of long-term survival of patients with this disease remains low, which, mainly, is the cause of the underlying severe liver disease.


| 15 May 2015 | | 2,224 | Surgery
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  • | Denisova Albina | 8 November 2015

    I found out that reflux esophagitis from which they are treating me hides the diagnosis of esophageal varicose veins I was diagnosed with. Your medical advice helped you.

Leave your feedback


mcboberson bob: i was doing clinical rotations and saw a patient code with one of her varices burst, she lost a little more than 2.5 L of her blood, they eventually stabilized her, didnt get to see what happened after that thought, pretty crazy stuff

cornel bacauanu: Super nice presentation . I placed my self, in the old days, the SB tube when Octreotide was not available and asked my self what will happen next … Thank you .

Abdulaziz Salam: Excellent video as always! Your videos are basically the best on YouTube. Will you make more liver/GIT related videos in the near future? They are really helpful.

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