Esophageal varices — a term for the extension in the lower part of the esophagus, which are the result of disorders of the circulation of the blood in the portal vein and, consequently, disorders of the gastro-esophageal plexus excessive amount of blood that flows, that is in search of outflow from the heart.
Due to the fact that for the varicose veins of the esophagus in 90% of cases cirrhosis of the liver, may appear yellowing of the skin and whites of the eyes, loss of appetite, decline in body weight, ascites, abdominal pain and nausea.
The most dangerous symptom of this disease is associated with hemoptysis, mixed with blood, vomiting, stopped the chair, and weakness.
Esophageal varices are present in its lower part, occurs because of phenomena of stagnation in the system of the portal vein of the liver, which appear of thrombosis and cirrhosis of the liver. The cause of this disease in the upper part is malignant goiter. The veins of the liver are compressed, which makes the flow of blood for him difficult. Phlebectasia esophagus appears also as a complication of diseases of the heart and of the spleen.
The factors that cause this disease:
- stenosis of the portal vein, characteristic for the younger generations, arising as a result of a thrombosis, multiple sclerosis;
- diseases of the liver, occurring in advanced age – related cirrhosis, amyloidosis, echinococcosis;
- disease Clear;
- angioma of the esophagus;
- malignant goitre;
Esophageal varices most often occurs in the following categories of patients:
- in men;
- in people over the age of 50 years;
- in patients with a history of diseases of the pancreas, stomach, heart, chronic cirrhosis.
On the occurrence of bleeding is not so much the level of pressure, how hard its variations. The risk of rupture is high and in those patients who suffer from cardiovascular diseases, adverse effects on the structure of the walls of the blood vessels.
Classification of the disease of esophageal varices is varied several times, however, now you are using a version of 1997 for the veins of the esophagus, which separates the disease for degrees:
- In the first instance. Veins of diameter reached 5 mm, visibly tense, are located in the lower level of the organ.
- To the second degree. Vienna twisted, with a diameter of up to 10 mm, are located in the central part of the organ.
- Of the third degree. Blood vessels are dilated up to 10 mm, wall-mounted, elongated, thin, close by are along to have red spots on the outer surface.
If esophageal varices, however, has caused internal bleeding, according to the statistics — and after him survive, only 50% of patients. More than half of the survivors after bleeding patients meet within 1-3 years with the relapse of this disease and are forced to re-start the treatment.
Varicose veins 1 degree
The clinical picture is poorly developed. The patient has practically no complaints. During the examination, observe: varicose veins are not strong, up to 3 mm., ectasias veins no, or only rare, the light is not full. Diagnosed only with the help of endoscopy. In the first instance it is important to as quickly as possible to begin treatment.
Varicose veins 2 degrees
Well-drawn irregularities of the blood vessels, as well as there are nodules larger than 3 mm. When the mucous membrane of the esophagus remain in integrity, without any violation of its integrity.
During the course of the research it is possible to diagnose a large swelling of the blood vessels. The treatment should be carried out in a timely manner, only in this way will get rid of the annoying symptoms of the disease in the initial phase. Bleeding is not typical in this phase.
Varicose veins are 3 degree
More often unchallenged diagnosis. The patient is highly expressed in the symptoms. Usually, in this case, it is prescribed the operation. The veins were very swollen, the nodes clearly emerge constantly advanced, occupy the 2/3 of the esophagus, the mucosa of the esophagus is strongly thinning. Occur gastroesophageal refluxes.
Varicose veins are 4 degrees
This is the extent of the disease is exposed, when in the esophagus are detected many nodules veins, not fall, and thinning-out the surface. For mucosae layer found numerous erosion. Patients record, as well as signs of esophagitis, salty, bitter taste in the mouth. The fourth grade most often results spontaneously arising from the hemorrhage.
The symptoms of varicose veins of the esophagus
The early years of the esophageal varices can occur without visible symptoms. Sometimes they are marked rare attacks of heartburn, weak sense of tightness in the chest, belching. Some patients complain of difficulty with swallowing food.
The symptoms of progressing of the disease a few days before the hemorrhage. Signs consist in the force of gravity in the chest, and the deterioration of the general health of the patient. In other patients, the symptoms may be expressed in the manifestation of ascites.
In addition to this, the symptoms of the disease of esophageal varices can occur in the form of occurrence of "head of medusa". This phenomenon is a kind of figure, which is quite clearly visible on the front of the abdominal wall several pathological formats, relief vessels, or veins.
After vienna, they break, occurs a severe hemorrhage, accompanied by the characteristic symptoms:
- greatly reduced the blood pressure;
- locate the impurities in the vomiting;
- locate the impurities in the stool;
- severe tachycardia.
With a small hemorrhage, the person may feel a little weak, unwell, and even symptoms of anemia. Diagnose varicose veins of the esophagus by means of laboratory tests, abdominal ultrasound, if necessary, perform the radiographic investigations and the diagnostics.
The diagnosis will be issued on the basis of complaints, external inspection, identification of primary disease. The search instrumental you refer to:
- the laboratory data of blood analysis;
- x-ray with contrast medium;
- the diseases that you need to keep clean because of the risk of any bleeding.
When the diagnosis of all possible causes must be taken into account and eliminated, only then will it be possible to finally and accurately determine the root cause of bleeding and modifications of the veins of the esophagus.
Treatment of esophageal varices
If you are experiencing the symptoms of varicose veins of the esophagus, the treatment is only carried out in the department of resuscitation or intensive care. The main classification non-surgical procedures aimed at the prevention and resolution of bleeding (hemostatic therapy), reducing the pressure in the blood vessels:
- The pharmacological treatment in the form of intake of vitamins, binders, medicines, and antacids (drugs that reduce the acidity of the stomach). This method aims at the prevention of peptic ulcer, esophagitis, the inflammation can pass on the walls of the blood vessels, causing the bleeding.
- A blood transfusion, red blood cells and plasma;
- The introduction of colloidal solutions;
- Welcome hemostatic, and contributing to a narrowing of the blood vessels of the drugs.
In the cases, if one of these methods is not enough to want to stop the bleeding, and there is the risk of re-vascular damage in the near future, the use of the following operations:
- transjugular intrahepatic portosystemic bypass (TIPS);
Also currently there is considerable experience of using mini-invasive endoscopic interventions for the resolution of bleeding of the esophageal veins. There are 2 ways of endoscopic sclerotherapy of the esophagus:
intranasally method of introduction of sclerosing involves the development of the connective tissue of the place of localization of the thrombosed veins of the site. When paravasal way, when the sclerosant is injected in the submucous layer, scarring occurs paravasal fibers and the consequent compression of the varicose veins of the esophagus. This method is gentler and has fewer complications.
Patients should throughout life follow a strict diet, despite the health conditions:
- often the food in small portions.
- the exception of hot and cold dishes.
- this is a low-fat soups, cereal diluted with milk or water, fruit juices, fruit in a shabby, steamed vegetables.
- are contraindicated spicy, sour, salty, fatty and fried meat products; it is necessary all to boil, to cook, in the form of puree.
Absolutely contraindicated alcohol, carbonated drinks, beer.
To avoid becoming healthy esophageal varices pathological, varicose veins in the first place, it is necessary to monitor the state of the liver and treat in a timely manner all of its diseases. For this reason, experts recommend regularly look to him for advice and follow all the recommendations.
Forecast for the life
Unfortunately, esophageal varices incurable. However, in the case of timely diagnosis of an appropriate maintenance treatment will significantly improve the patient's quality of life and help prevent the terrible condition – the bleeding.
Mortality when it is already arisen bleeding from esophageal varices is more than 50% and depends on the severity of the disease and the condition of the body in general. In survivors after hemorrhage, patients in 75% of cases within the next 1-2 years, there has been a relapse.
In general, the long-term prognosis the survival of patients with this disease remains low, and, above all, serves the main fault of a serious liver disease.