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Varicose veins of the esophagus develops as a result of the violation of the blood flow in the portal and the top and the depressions of the veins. Observed this pathology in the department of the esophagus or proximal stomach. By the nature of the apparition can be innate and acquired. The latter, moreover, does not depend on the age of the patient, and the obligation of the state and of the obstacles to the normal blood circulation in the system of the portal vein.
The extension of the esophageal veins with the portal hypertension of different origin. During this release:
Varicose veins of the lesions of the veins of the esophagus at a young age are more likely to be caused by the blockade of the liver in adults – inside of the liver.
The causes of the disease caused by anatomical connection of the veins of the esophagus with the system of the portal vein, veins, organs of the abdominal cavity, in particular, the spleen. The inside of the form of a blockade of liver blood flow pathology covers the lower part of the esophagus, this is due to the stagnation of the process in the portal vein of the liver, which occur when:
This blockade of blood circulation due to thrombosis of the portal vein, compression of his tumor, lymph nodes, cysts or stones in the bile ducts. Varicose veins in the departments also happens when malignant goitre, or disease of the esophagus, as well as the vascular changes in patients with rare diseases.
More rarely, the disease develops by the increase of the pressure in the system of blood circulation, which is indicated in the case of the chronic insufficiency of the cardio-vascular system. A symptom is something that the vascular nodes if the liver disease is 2-3 times larger.
There are also innate to the form of lesions of the esophagus, the reasons are not clear.
When the difficulty of outflow of blood veins of the esophagus in them begin to develop the extension, tortuosity and elongation. The walls of the blood vessels when this thin and can rupture, which involves the development of a bleeding. The thinning of blood vessels and venous is not balanced, increase, form extensions local in the form of nodes.
The progression of the disease can be rapid and can take place extremely slowly. Very often, appeared on the disease for several years may not manifest. The patient disturbs a few uncertain of the complaint, among them:
Example of the age of patients is about 50 years, the men among patients with two times more than women.
The development of the hemorrhage is the most dreaded complication of varicose veins of the esophagus. It may be imperceptible to the patient, and may pose a threat to his life. The main symptom is vomiting, marked with the blood. The same is not hazardous to the spirit, the knowledge from regular, but the loss of blood can cause iron-deficiency anemia.
The cause of the development of such bleeding can be:
Sometimes, bleeding can occur suddenly among full health and adopting a generous nature, can result in death. The precursors are a slight titillation in the throat, characteristic of the salty taste in the mouth. Shortly after their unexpected appearance occurs vomiting red or resembling coffee grounds in the blood. Sometimes, bleeding causes the execution of the disease, the need for an early diagnosis of the disease.
Varicose veins of the esophagus can be observed in 70% of patients with cirrhosis of the liver. This phenomenon can be explained by the fact that the cirrhosis of the liver, the formation of scarring tissue, pre-emption healthy cells. It slows down blood circulation and causes stagnation, which are at the origin of the development of this pathology in the departments of the esophagus. Variceal bleeding is the cause of death with cirrhosis in 10-15% of cases. The most formidable diagnostic sign are the first relapse.
For this reason, patients with cirrhosis of the liver must be submitted to the regular endoscopic screening for varices. In the absence of extension of the esophagus the veins of the frequency of these examinations should be once in 2 years, if applicable, one or 2 times per year. The frequency and degree detected varicose veins usually proportional to the severity of the cirrhosis.
In the treatment of these patients is of great importance to the prevention of re-bleeding. It is based on the use of drugs which reduce the portal pressure, endoscopic sclerotherapy and chirurgiques. It should be noted that the prevention of the recurrence was more less good results than the prevention of a first bleeding episode.
To make the diagnosis, the following types of research:
The main here is to the execution of the procedure, which gives the possibility to establish the causes of hemorrhage, to determine the state of the vein wall and the degree of dilation of the veins as well as predict the rupture plain of the aneurysm. If the bleeding has already started, the cause is often difficult to establish because of the difficulty in the effective conduct esophagoscopy.
The part of the information on the state of the esophagus and of the nature of varicose veins, you can get on the basis of the x-ray of the esophagus, done with contrast.
As well as the condition of varicose veins is usually associated with a severe liver disease, it is important to assess the degree of coagulopathy. To do this, perform general analyses of blood to the definition of the platelet count and the index of prothrombin, as well as liver-function tests. When the presence of bleeding must be defined the blood group, rhesus-factor and re-test on the compatibility of the red blood cell mass.
The differential diagnosis should exclude the possibility of many other diseases, such as:
The treatment of varicose veins of the esophagus is to eliminate the diseases that have led to an increase of the pressure in the portal system and the vena veins, as well as eliminating the threat of a possible hemorrhage. These measures also concern the prevention of esophagitis, fresh way of life, the reception of medications – antacids, vitamins, laxatives.
If you are experiencing bleeding, which is taken the following measures:
To compensate for the blood loss of the patients are transfusion, infusion of the red blood cell mass or plasma solutions.
When bleeding, it is necessary for more severe, a surgical intervention, which can significantly reduce the mortality. It is noticed that when the conservative treatment of the case-fatality rate of 3 times compared to surgery. Secrete of palliative and radical surgery to correct the esophageal bleeding.
At the present time, there is an important experience of using minimally invasive endoscopic procedure to resolve the bleeding of the esophageal veins.
Endoscopic cure was described for the first time in 1939. Only in the 70s of the last century in the framework of the development and the improvement in endoscopic facilities, has been launched intense of the implementation of the method in practice. It uses tools with different mechanisms of action.
Improve the results of sclerotherapy using the application of balloon tamponade.
Good results allows to achieve the endoscopic method the doping, which was proposed in 1985. As a result of the termination of blood flow in the veins of the esophagus is done with the help of alloy rings. Relapses after such an intervention, have been observed only in 17% of patients, which is almost two times less than after sclerosing.
This method is used to stop bleeding by crushing of the bleeding site. It is quite dangerous and should be performed only by an experienced technician. The main tool is a special probe with a tank. Arrest of bleeding is achieved with the help of bloated stomach of the bottle and traction without ambiguïte
Treatment of the esophagus of the bottle. Thanks to this product tamponade varices, and decreases the intensity of bleeding from the venous plexus. Bloating lower esophageal of the bottle is actually very rare, which explains the risk of complications.
The effectiveness of using balloon tamponade is 90%.
For the treatment of this disease apply surgical methods:
The methodology TIPS is intrahepatic to the creation of an artificial channel between the hepatic and portal veins and installation in the ducts metal stent. Thanks to it, almost always impossible to stop the bleeding, including not to give in to other types of therapy. The main disadvantage of the method is its great complexity and required the subsequent development of hepatic encephalopathy.
The effectiveness of bypass surgery close to the efficiency TIPS is much greater travmatichnosti. The onset of hepatic encephalopathy is also a problem.
Some operations consist of the intersection of the esophagus. This type of surgery is effective in helping to stop the bleeding, is not by eliminating the causes of portal hypertension, which leads to relapse rapid development of this pathology.
Forecasts determined by the main weight of the liver disease. In general, varicose veins is characterized by a high mortality rate, which exceeds 50%. Case fatality rate is determined not on the severity of the hemorrhage, and the nature of the liver disease, have led to him.
Although 80% of patients bleeding will stop independently, will recover this mainly for the sick that distinguishes a good functional state of the liver, but for patients suffering from a deficiency in hepatocellular, it often proves fatal.
In survivors after hemorrhage, patients in 75% of cases in the next 1-2 years, there has been a recurrence. Reduces the risk of this regular drug abuse and that the endoscopic treatment of varicose veins.
In general, the long-term prognosis of patients with this disease remains low, which, primarily, serves as the fault fundamental of the serious liver disease.
