Expansion of the veins of the stomach symptoms and treatment. Varicose veins of the esophagus and stomach - what is it, causes, what is dangerous, methods of treatment

Extensive portal-systemic venous collaterals become a direct consequence of portal hypertension. They are formed when existing veins expand to reduce pressure in the hepatic portal system. The persistence of portal hypertension after collateral formation is associated with increased blood flow in the spleen as a result.

Collaterals form primarily in the following areas.

The left gastric vein and the short gastric veins connect with the intercostal, diaphragmatic, esophageal, and azygous veins of the portal system.

Remains of the fetal umbilical circulatory system in the falciform ligament of the liver lead to dilation of the paraumbilical veins.

Others: retroperitoneum, lumbar veins, omental veins.

The leading complication of portal hypertension is bleeding from thin-walled varicose veins of the stomach and lower esophagus. Bleeding from varicose veins begins for no apparent reason and is usually manifested by profuse, painless vomiting of blood or chalk.

Bleeding from varicose veins indicates primarily portal hypertension. The role of gastroesophageal reflux in the development of bleeding is not clear. Although there are differing opinions about whether there is a direct relationship between bleeding and the severity of portal hypertension, everyone agrees that bleeding occurs when the pressure in the portal vein is more than 12 mm Hg. Art. and more likely with large varicose veins.

Varicose veins are dilated veins in the distal esophagus caused by increased pressure in the portal venous system, usually in cirrhosis of the liver. Varicose veins can be complicated by massive bleeding in the absence of other symptoms. The diagnosis is established by endoscopy of the upper gastrointestinal tract. Treatment is primarily with endoscopic ligation and intravenous administration octreotide.

Portal hypertension develops due to various causes, primarily with cirrhosis of the liver. If the pressure in the portal vein exceeds the pressure in the inferior vena cava for a significant period of time, venous collaterals develop. Collaterals, which carry the highest danger, are located in the distal part of the esophagus and the fundus of the stomach and look like swollen tortuous vessels of the submucosal layer, referred to as varicose veins. These varicose veins provide a partial reduction in portal pressure, but they can rupture with the development of massive gastrointestinal bleeding. The factor provoking the rupture of varicose veins remains unknown, however, it has been established that there is practically no development of bleeding until the portal/systemic pressure gradient reaches > 12 mm Hg. Coagulopathy as part of liver disease exacerbates the risk of bleeding.

Symptoms and signs of varicose veins of the stomach and lower esophagus

As a rule, the picture of bleeding from the upper gastrointestinal tract, often massive, develops suddenly, without pain. There may be signs of shock. Blood loss usually occurs from the lower part of the esophagus, less often from the fundus of the stomach. Blood loss from gastric varicose veins can also be acute, but more often subacute or chronic.

Bleeding into the lumen of the gastrointestinal tract with impaired liver function contributes to the growth of porto-systemic encephalopathy.

Diagnosis of varicose veins of the stomach and lower esophagus

• Endoscopy.
• Studies to detect coagulopathy.

Varicose veins can be detected on X-ray examination of the upper GI tract with barium contrast (sensitivity is 40%), angiography and endoscopic examination. The preferred method is endoscopic examination of the upper gastrointestinal tract, it allows not only to identify varicose veins and determine their size, but also to clarify whether they are a source of bleeding. In patients with cirrhosis of the liver and with varicose veins of the esophagus and stomach, in 40% of cases they are not the source of bleeding. In these cases, bleeding is due to erosion and bleeding of the gastric mucosa.

Esophageal and gastric varicose veins are best identified by endoscopy, and nodes with a high risk of bleeding (with red spots of vasculopathy) can also be identified. Endoscopy is important to rule out other causes of acute bleeding (eg, peptic ulcer), even if varicose veins are already established.

Since varicose veins develop against the background of severe liver damage, it is important to evaluate possible violations blood clotting. Laboratory research include a clinical blood test with a platelet count, an assessment of liver function indicators.

Prognosis of varicose veins of the stomach and lower esophagus

If large esophageal varices are found, the risk of bleeding within 1 year after diagnosis is 25-35%. Risk factors for bleeding include the size of the nodules, the severity of cirrhosis, and alcohol abuse. The prognosis depends on the degree of exhaustion, the presence of ascites, encephalopathy, serum bilirubin and albumin levels, and prothrombin time.

In about 40% of cases, bleeding stops spontaneously. In previous years, mortality was > 50%, but even with current treatment options, the rate of death by week 6 is at least 20%. Mortality depends more on the severity of the underlying liver pathology than on the blood loss itself. In severe liver damage (eg, severe cirrhosis), bleeding is often fatal, but with good liver reserve capacity, the outcome is usually favorable.

Patients who have had an episode of bleeding are at high risk of recurrence; the frequency of relapses in the next 1-2 years is 50-75%. Performing an endoscopic or drug treatment significantly reduces the risk of recurrence, but the effect of these drugs on overall survival seems to be limited due to the severity of underlying liver disease.

Treatment of varicose veins of the stomach and lower esophagus

• The introduction of plasma substitutes.
• Endoscopic ligation of varicose veins (reserve method - sclerotherapy).
• Intravenous administration of octreotide.

Measures to combat hypovolemia and hemorrhagic shock. For coagulation disorders (for example, an increase in MHO), it is necessary to transfuse 1-2 doses of fresh frozen plasma and administer 2.5-10 mg of vitamin K intramuscularly. In the presence of cirrhosis of the liver with gastrointestinal bleeding, the risk of bacterial infection increases; prophylactic administration of antibiotics - norfloxacin or ceftriaxone is indicated.

Because endoscopy always reveals varicose veins, the main methods of treatment are endoscopic interventions. Endoscopic ligation is preferred over injection sclerotherapy. Simultaneously, octreotide is administered intravenously. Octreotide increases splanchnic vascular resistance by suppressing the release of vasodilating hormones internal organs(particularly glucagon, a vasoactive intestinal polypeptide). The standard dose is 50 micrograms intravenously as a bolus, followed by a rate of 50 micrograms/hour. The introduction of octreotide is more preferable than previously used vasopressin and terlipressin due to the lower frequency of adverse events.

If, despite the measures taken, bleeding continues or recurs, urgent interventions should be considered to bypass blood from the portal vein system to the inferior vena cava, which help to reduce pressure in the portal vein and reduce the intensity of bleeding. Among emergency procedures, TIPS is the method of choice. This is an invasive procedure under x-ray control, in which a guidewire is passed from the inferior vena cava to the branches of the portal vein through the hepatic parenchyma. Along the guidewire, a balloon catheter is expanded and a metal stent is introduced - an artificial porto-hepatic venous shunt. The stent size is essential. If it is excessively large, there is a risk of developing porto-systemic encephalopathy due to a large flow of portal blood into the systemic circulation. If the stent is too small, there is a risk of occlusion. Surgically formed porto-caval shunts such as k, f distal splenorenal shunt, "work" in a similar way, however, these interventions are more traumatic and carry a greater risk of death.

Mechanical compression of bleeding varicose veins with a Sengstaken-Blackmore probe or its analogues carries a high risk of complications and should not be used as an intermediate first choice. However, tube tamponade appears to be a lifesaver for delayed TIPS. After the introduction of the probe, the gastric balloon is inflated with air of a certain volume, then the balloon is firmly installed against the gastroesophageal junction by pulling force. Often, to stop bleeding, it is enough to install this balloon.

The intervention causes quite a lot of discomfort and can lead to perforation of the esophagus and aspiration.

Liver transplant also promotes portal venous decompression, but is only suitable for patients already on the Liver Transplant Waiting List.

Long-term therapy of portal hypertension (with the use of |3-blockers and nitrates) is discussed in the appropriate section. It may be necessary to treat portosystemic encephalopathy.

Timely treatment for profuse vomiting of blood or melena requires well-coordinated work therapists and surgeons.

Transfusion of blood components. First of all, it is necessary to replenish blood loss by transfusion of whole blood, fresh frozen plasma and, if necessary, platelet mass. Since liver cirrhosis is usually deficient in clotting factors, it is very important to transfuse fresh whole blood or fresh frozen plasma.

Endoscopy or angiography.

Choice of treatment method. There are several approaches to the treatment of active bleeding from varicose veins.

If these methods are not available, medical therapy or balloon tamponade or percutaneous transhepatic embolization of varicose veins is performed. Surgical treatment (portocaval shunting) is associated with a very high mortality, but can save the patient's life. Transjugular intrahepatic portocaval shunting (insertion of a self-expanding stent into the liver by transjugular access) is associated with much lower mortality and morbidity.

Endoscopic sclerotherapy, which consists in the direct injection of a sclerosing agent into varicose veins of the esophagus, is well suited for stopping bleeding. Sclerotherapy is usually started before vasopressin is given or balloon tamponade is performed. The most commonly used sclerosing drugs are sodium tetradecyl sulfate, sodium morrhuate, and monoethanolamine oleate. The sclerosing agent is injected directly into the wall of the varicose vein or into the mucosa between the nodes. As a result, the varicose vein is thrombosed and a severe necrotizing inflammation of the esophageal wall develops, followed by a pronounced fibrotic reaction.

After stopping the bleeding, sclerotherapy is repeated weekly or monthly, and scars of the esophagus are formed. The effectiveness of sclerotherapy of gastric varicose veins has not been proven, in addition, the formation of ulcers is possible. Complications of endoscopic sclerotherapy of esophageal varices include ulceration, bleeding, perforation and stricture of the esophagus, and pleural effusion. Sclerotherapy can stop bleeding in 80-90% of cases.

Endoscopic ligation of varicose veins even somewhat surpasses sclerotherapy in effectiveness as a means of stopping bleeding from varicose veins of the esophagus. The procedure requires experience and a calm state of the patient. Tracheal intubation and tranquilizers may be required.

Medical therapy. Although endoscopic ligation and sclerotherapy of varicose veins is universally the treatment of choice for bleeding, drug therapy can be a useful adjunct, especially in severe bleeding and in cases where the source of bleeding is unavailable for sclerotherapy. In acute bleeding from varicose veins, the following drugs are used: vasopressin and its analogues in combination with nitrates or as monotherapy, somatostatin and its analogue octreotide.

• Vasopressin. Parenteral administration of vasopressin leads to a narrowing of the vessels supplying blood to the internal organs, and a decrease in pressure in the portal system of the liver. There is no clear evidence that the administration of the drug into the superior mesenteric artery is more effective or safe than intravenous administration. Initially, it is preferable to administer the drug in / in. Complications of vasopressin therapy include generalized vasospasm leading to ischemia of the myocardium and peripheral tissues, lactic acidosis, arrhythmias, and hyponatremia (the action of ADH).
• Nitrates. The administration of nitroglycerin (sublingually, as a nitroglycerin patch on the skin or intravenously) reduces the effect of vasopressin on peripheral vessels and additionally reduces pressure in the portal vein due to a direct vasodilating effect on portal-systemic collaterals. The drug is prescribed in the following doses: in the form of a patch,; sublingually.
• Somatostatin appears to selectively reduce visceral blood flow and thus portal pressure. In terms of effectiveness, it is not inferior to vasopressin, while its adverse effect on hemodynamics is much less. Somatostatin can be prescribed for a long time. Possible side effects include nausea, abdominal pain and, with long-term use, mild glucose intolerance. Equally effective is octreotide, a synthetic analogue of somatostatin.

Balloon tamponade. The Sengstaken-Blakemore probe and the Minnesota probe have two balloons - an elongated esophageal and a round gastric balloon and holes for removing the contents of the stomach and upper esophagus. Packing with a Sengstaken-Blakemore probe stops bleeding at least temporarily in 90% of patients. Many of the difficulties associated with this procedure can be avoided if the patient is in the ward. intensive care. The probe is inserted through the mouth or nose, the gastric balloon is inflated with 250-300 ml of air and placed in the area of ​​the gastroesophageal junction. complications of balloon tamponade are ischemia of the mucosa of the esophagus or stomach, their rupture and aspiration of gastric contents. The longer the balloon is inflated, the higher the chance of complications, so the balloon should be deflated after 24 hours. If the bleeding has stopped, after another 24 hours the probe can be removed.

Percutaneous transhepatic embolization or sclerotherapy of varicose veins in 70% of cases can stop bleeding. However, later it usually resumes. This method should be used only when treatment is ineffective.

Portocaval shunting. Recurrent or ongoing bleeding may be an indication for porto-caval bypass surgery, in which pressure in the portal vein is reduced surgically. This major operation, when performed on an emergency basis, is associated with a mortality rate of about 40%. If it is possible to perform a porto-caval shunt in a planned manner, the mortality rate is much lower. Porto-caval shunting does not increase life expectancy, but it prevents new bleeding. Since much of the blood bypasses the liver into the vena cava, reduced blood supply to the liver in most patients leads to liver failure and persistent encephalopathy. When applying a distal splenorenal anastomosis, a type of portocaval shunting, with a simultaneous decrease in the blood supply to the esophagus and stomach, the pressure in the esophageal varicose veins is selectively reduced while maintaining blood flow through the liver. In many studies, distal splenorenal shunting reduced the incidence of severe encephalopathy compared to other porto-caval shunting options. However, this procedure is difficult to perform and is contraindicated in severe persistent ascites, since ascites usually increases after it. Emergency porto-caval shunting was compared with endoscopic sclerotherapy for severe decompensated alcoholic cirrhosis of the liver with bleeding from varicose veins. After shunting, bleeding resumed less frequently, but liver failure and encephalopathy developed more frequently. Survival in both groups was comparable.

Transjugular intrahepatic portocaval shunting. Partially reduce the pressure in the portal system of the liver by creating a shunt between the hepatic and portal veins by subcutaneous transjugular access. The use of self-expanding metal stents prevents shunt occlusion due to the elasticity of the liver parenchyma. After transjugular intrahepatic porto-caval shunting, the pressure in the portal vein decreased from 34 to 22 mm Hg. Art., which led to a stop of bleeding from varicose veins. In 90% of cases, graft patency persists for up to 6 months and can be restored by dilatation or stent re-insertion. Late complications of the method include encephalopathy and ascites, which develop in 10-20% of patients.

Other surgical interventions. With persistent acute bleeding from varicose veins, dissection of the esophagus, devascularization of its distal part and proximal parts of the stomach, and splenectomy were also used. Mortality in these interventions is extremely high, and they are rarely resorted to.

Liver transplant. With moderate cirrhosis of the liver, transplantation is not necessary; it should be performed only in severe irreversible liver damage.

Primary and secondary prevention of bleeding from varicose veins with cirrhosis of the liver. It has been shown that non-selective (3-blockers) reduce pressure in the portal system of the liver, reduce the risk of first bleeding from large varices, as well as the frequency of rebleeding. These drugs can improve survival in liver cirrhosis. According to the ability to reduce the risk of first bleeding in liver cirrhosis, propranolol does not inferior to long-acting nitrates (eg, isosorbide mononitrate), have fewer side effects than propranolol, and can be used as an alternative to β-blockers.

Beta-blockers have some efficacy even in decompensated liver cirrhosis. Propranolol also reduces the risk of bleeding from varicose veins of the stomach. These drugs should not replace sclerotherapy or ligation of varicose veins to stop bleeding. They should be considered as additional remedy with long-term therapy of portal hypertension.

A detailed description for our readers: gastric varicose veins causes on the site site in detail and with photos.

Varicose veins develop when the blood supply to the stomach is interrupted. The condition is usually accompanied by a change in the structure of the vessels, such as expansion, elongation, the formation of loops or knots. Pathology appears against the background of liver damage, in particular, with cirrhosis. Invariable companion of varicose veins in the tissues of the stomach are small or heavy bleeding.

Varicose veins of the stomach are dangerous pathologies. The condition is characterized by an increase, often expansion, of the veins of the organ with the formation of blood clots. The insidiousness of the disease lies in the absence of symptoms at an early stage, so timely diagnosis is almost impossible. Mostly men suffer from this disease. The main provoking factors in the development of the disease, as well as liver damage, are:

• alcohol;
• unhealthy diet;
• uncontrolled drug treatment.

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Symptoms

Varicose veins veins of the stomach is characterized by the scarcity of the clinical picture. Symptoms are often similar to other gastrointestinal pathologies. However, there are distinguishing features:

1. Hematemesis with black vomit, which indicates the discovery of gastric bleeding. Vomiting may be rapid with impurities of pink mucus.
2. Increased heart rate with frequent failures.
3. Soreness in the abdomen.

The initial stages of gastric varicose veins are often accompanied by severe heartburn, which, although it brings discomfort, does not cause the need to go to the doctor. As the pathology develops, gastric bleeding opens. This condition is accompanied by symptoms such as:

• ascites, when free extrudate accumulates in the peritoneum, which provokes a strong increase in the size of the abdomen;
• profuse, bloody vomiting that does not cause pain;
• tachycardia with confused and rapid pulse;
• hypotension, characterized by a sharp decrease blood pressure;
• hypovolemic shock, accompanied by a sharp decrease in the effective volume of circulating blood.

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Causes of varicose veins of the stomach

Varicose veins of the stomach appear as a result of portal hypertension or increased pressure in the portal vein. Normal pressure in this vein - up to 6 mm Hg. Art. If this value jumps to 12-20 mm Hg. Art., blood flow is disturbed and vasodilation occurs. The root cause of portal hypertension is compression of the portal vein, which can cause thrombosis or prolapsed stone when cholelithiasis. Also, the causes of varicose veins of the stomach are:

• dysfunction of the pancreas, stomach;
• cirrhosis, hepatitis;
• echinecoccosis;
• tuberculosis;
• polycystic;
• acquired or congenital fibrosis;
• sarcoidosis;
• tumors, cysts, adhesions of various etiologies;
• aneurysms of the arteries of the spleen or liver;
• eosinophilic gastroenteritis;
• bowel obstruction;
• general

Sometimes varicose veins of the stomach are preceded by a sharp load: lifting weights, severe fever. Rarely the disease is congenital. The reasons for this anomaly have not yet been found.

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Diagnosis of the disease

Detection of varicose veins is possible only with instrumental examination. For this, the following methods are used:

1. General and clinical blood tests, which is necessary for evaluation general condition sick.
2. Functional and hepatic examinations to determine coagulopathy.
3. X-ray with contrast (barium sulfate), performed to evaluate the functionality of the digestive tract.
4. Esophagogastroscopy, used to visualize the state of the internal walls of the stomach. The method is highly accurate, but requires heightened attention and accuracy, since the affected tissues are fragile and the probe can provoke bleeding.
5. Ultrasound of organs abdominal cavity necessary to confirm the diagnosis.

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Treatment

There are three approaches to treatment:

• therapeutic;
• medication;
• surgical.

The first two schemes apply to early stages or after effective control of bleeding. Late stages are treated only surgically, as the risk of death associated with hypovolemic shock is high. The main approaches to the treatment of gastric varicose veins are presented below.

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Sclerotherapy

The essence of the method is the introduction of special medical glue into the affected vessels by endoscopic method. A certain frequency of the procedure is required, which is determined by the doctor individually. More often, the technique is applied once every 7 or 30 days, and ends with the formation of a persistent scar.

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Operation

Surgery can be done in three ways:

• Ligation of dilated veins. For this, a special rubber bandage is used. The effectiveness of the technique is higher than sclerotherapy.
• Shunting in intrahepatic tissues. The technique is necessary to lower the pressure. To do this, a stent is inserted into the middle of the liver. The procedure is done under X-ray control. The goal is to create a connecting bridge between the hepatic and portal veins.
• Splenorenal shunting. The technique is used for preventive purposes - to prevent the development of bleeding. For this purpose, the veins of the spleen and the left kidney are combined with a shunt.

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Medical therapy for varicose veins

The essence of the method is the regular intake of such means as:

• "Vasopressin" - to restore the normal state of constricted blood vessels;
• nitrate containing "Nitroglycerin" - to reduce pressure in the portal vein;
• "Somatostatin" or "Octreotide" - to lower blood pressure in the internal organs and restore the normal state of dilated vessels.

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diet therapy

For the treatment of varicose veins of the stomach, it is important to follow proper nutrition. The main principles are as follows:

1. Fractional meals in small portions - up to 6 times a day.
2. The last snack is 3 hours before going to bed.
3. Increase in the diet the number of foods rich in vitamins such as:
   • vitamin E (greens, yolk, corn or sunflower oil);
   • vitamin C (berries, potatoes, fresh peppers, all kinds of citrus fruits);
   • rutin (nuts, tea, grapefruit, currant);
   • bioflavonoids (cherries with sweet cherries);
   • vegetable fibers (legumes, fresh vegetables and fruits).
4. Organization of abundant drinking - up to 2.5 liters of water per day.
5. Complete rejection of harmful products:
   • alcohol;
   • concentrated black tea, coffee;
   • sweets and sugar;
   • hot seasonings and spices;
   • flour products.
6. Preferred cooking - boiling, baking in the oven, stewing, steaming.
7. Dishes must be warm.

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Prevention

The essence of preventive measures is to preserve healthy condition veins. For this you should:

• monitor the condition of the liver;
• exactly follow the doctor's recommendations;
• regulate in a timely manner high blood pressure;
• follow the rules of a healthy lifestyle bad habits, proper nutrition).

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Complications

The most severe complication of varicose veins of the stomach is bleeding. They can even occur from overeating due to a strong thinning of the walls of the organ. The amount of bleeding can be different, as is their frequency. The outcome depends on this. Bleeding causes severe vomiting, chronic iron deficiency.

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Nerves and varicose veins

The state of the body and its performance depend on the stability nervous system. When a person is exposed to significant prolonged stress, experiences, depression, first of all, the digestive system suffers. Neurological causes development of varicose pathology:

1. Chronic state of hatred.
2. Feeling of chronic fatigue, severe overexertion.
3. Decline in strength and spirit, disappointment and moral fatigue.

Therefore, during treatment, a positive attitude is important, the elimination of all irritating factors.

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Forecast

Mortality in gastric varicose veins is high due to the severity of complications and comorbidities. More often, bleeding problems with the vessels of the main digestive organ are associated with progressive cirrhosis.

In 79% of cases, bleeding stops on its own with a mortality rate of 50%. After successful relief of the disease, the risk of returning the disease is 55-75%.

Varicose veins of the stomach - a pathological expansion of blood vessels, which develops under the influence of increased pressure in the portal vein. Varicose veins of the stomach manifest themselves in the form of protrusion and swelling of the walls and the formation of nodes. Varicose veins of internal organs, including the stomach, is a fairly rare pathology that is difficult to diagnose in the initial stages of development.

Varicose veins of the stomach

Varicose veins of the gastric vein can be congenital or acquired. Depending on how strongly ectasias (varicose veins) are manifested, there are 4 degrees of varicose veins of the stomach:

1. There are no clinical manifestations of the disease. It is possible to establish the initial stage only with the help of endoscopic examination. At the same time, the veins in the stomach are slightly dilated, in small areas on single vessels.
2. The first signs of the disease appear, but they are so weak that it is impossible to suspect a pathology. Blood vessels acquire a tortuous character, areas of swelling and narrowing alternate.
3. The patient's condition is deteriorating. When conducting an endoscopic or x-ray examination, pronounced ectasias are visible.
4. Nodes are formed, the diameter of which is more than 1 cm greater than the lumen of the vein. Affected vessels are thin and weak. This condition threatens not only a sharp deterioration in the health of the patient, but also his life.

The reasons

With gastric varicose veins, the causes of the development of pathology are different, the main of which is an increase in pressure in the portal vein, which leads to the formation of ectasias.

Varicose veins of the stomach are a consequence of other diseases:

• liver pathology (cirrhosis, hepatitis, echinococcosis, etc.);
• tuberculosis;
• polycystic;
• malignant or benign formations located in the region of the portal vein, and provoking its compression;
• fibrosis or sarcoidosis;
• aneurysms of arteries located in the liver or spleen;
• diseases of the gastrointestinal tract (eosinophilic gastroenteritis, intestinal obstruction);
• cardiovascular failure.

Provoking factors for the development of pathology include physical or mental overstrain, infectious diseases, accompanied by a significant increase in body temperature.

Based on which signs and symptoms of varicose veins prevail, the doctor develops an individual treatment regimen. After all, pathological varicose veins can be localized not only in the stomach, but also pass to the vessels of the abdominal cavity or esophagus, provoking new symptoms.

Signs and symptoms of the disease

Varicose veins of the stomach have similar symptoms with pathologies of the gastrointestinal tract. The main ones are nausea and heartburn.

Specific signs appear only in the later stages of the disease. First of all, this is bleeding from varicose veins. It manifests itself in the form of vomiting with blood impurities, which is not accompanied by painful sensations. The feces acquire a black tint, which indicates bleeding in the upper gastrointestinal tract.

In the abdominal cavity, fluid forms and begins to accumulate, which leads to the appearance of ascites.

In addition, there are pains in the heart area, increased heart rate, chest pain and shortness of breath, especially after physical or mental stress. A sharp decrease in blood pressure develops against the background of massive blood loss. In some cases, the patient's condition is complicated by hypovolemic shock.

Diagnostic measures

Varicose veins of the stomach are often accompanied by pathological dilatation of the veins in the esophagus. Diagnosis of the disease includes establishing the cause that provoked the occurrence of phlebectasia. Depending on this, an individual therapeutic scheme is developed.

The diagnosis is established on the basis of patient complaints, examination results, laboratory and instrumental research methods.

The doctor does not always associate heartburn with the development of gastric varicose veins, so if you have health complaints, you should undergo a comprehensive examination and not give up even the most unpleasant studies.

Varicose veins lead to the accumulation of free fluid in the abdominal cavity, as evidenced by an enlarged abdomen.

From laboratory tests, it is necessary to conduct general clinical studies of blood, urine and feces.

The most accurate method for diagnosing gastric varicose veins is esophagogastroscopy, which makes it possible to visually assess the state of the vessels of the organ, establish the presence of areas of pathological expansion, nodes and the exact place of bleeding. The study should be approached very responsibly so as not to provoke damage to thin vessels.

According to the results of esophagogastroscopy, one can not only verify the varicose veins of the stomach, but also establish the cause of the development of the pathology. This is evidenced by certain signs - a combined lesion of the vessels of the stomach and esophagus is a symptom of portal hypertension, selective stretching of individual sections of the vessels - about thrombosis of the veins of the spleen, etc.

From additional methods studies use radiography with barium sulfate (radiocontrast agent), which can be used to determine the functionality of the gastrointestinal tract.

Ultrasound examination will help to establish the lesion of the abdominal organs.

Methods of treatment of varicose veins of the stomach

Therapy for pathological expansion of the veins of the stomach is selected individually for each person, depending on the symptoms present and the stage of pathology.

Medical treatment

It is used in the initial stages as the only method of treatment or in combination with surgical methods. With its help, you can stabilize the patient's condition, prevent the progression of the disease and avoid complications.

From medications use drugs that have the ability to reduce pressure in the blood vessels of the internal organs and the portal vein, strengthen the tone and elasticity of the walls, and narrow the lumen.

Fixed assets:

1. Vasopressin. It has a vasoconstrictive effect, reduces pressure in the portal vein of the liver. Due to this, the overfilling of the blood vessels of the organ is eliminated and the patient's condition is stabilized. Vasopressin is intended for intravenous administration. From side effects the development of massive vasospasm is not excluded, which threatens with ischemia of the myocardium, brain and other important organs.
2. Nitrates. Reduce the negative effect of Vasopressin on peripheral vessels. Expands the portal-systemic collaterals, thereby reducing the pressure in the portal vein. It is used sublingually (under the tongue) or as a patch.
3. Somatostatin. It has the ability to selectively affect the blood vessels of internal organs. Due to this, it normalizes pressure in the veins of the stomach, restores blood vessels.

In addition, collide solutions, astringents, antacids and vitamins are widely used in the treatment of the disease.

Surgical intervention

It is used in the later stages of the disease, as well as in the event of massive bleeding from veins and nodes.

Good results are shown by intrahepatic shunting. The operation is performed under x-ray control. This creates a kind of bridge between the hepatic and portal veins, which makes it possible to reduce pressure and prevent its increase in the future.

If the pathology of the vessels of the spleen became the cause of the development of varicose veins of the stomach, it is advisable to use splenorenal shunting. In this case, the veins of the spleen and the left kidney are combined. Such manipulation is also indicated in order to prevent bleeding.

One of the most common surgical methods treatment of pathology is sclerosis. The essence of the procedure is the introduction of a special solution into the lumen of the vessel, which leads to soldering of the walls of the veins. To achieve the desired effect, the manipulation should be repeated several times - after 5 days, 1 and 3 months. One of the main disadvantages of this honey is the need for re-sclerosing every 6-12 months.

Surgical treatment of varicose veins includes ligation of pathologically dilated vessels. For this purpose, a rubber band is used. The method is characterized by high efficiency and minimal risk of recurrence.

Folk remedies

Alternative medicine is used in the composition complex treatment diseases, however, before using any method, you should agree on its appropriateness with your doctor. Despite all the safety, folk remedies have certain contraindications that must be taken into account.

In the treatment of pathology, medicinal plants are used that have the ability to strengthen the walls of blood vessels, increase their tone and elasticity.

Basic recipes:

1. Collection based on chestnut fruits. To prepare the medicine, you need to mix 100 g of chestnut fruit, oak and birch bark, blackberry roots and sweet-leaved astragalus, add 2 tbsp. l. horsetail and Icelandic moss. Grind and mix all components, 2 tbsp. l. mix pour 0.5 liters of hot water, put in a water bath and boil for 5-10 minutes. Before use, strain the medicine and take 100 ml 3-4 times a day. The decoction reduces the permeability of blood vessels, stabilizes blood circulation and removes swelling.
2. Berries of mountain ash and wild rose. They have anti-edematous properties, strengthen the walls, increase their tone and elasticity. 2 tbsp. l. berries should be poured with 0.5 liters of boiling water, wrapped and infused for 50-60 minutes. Means to take 100-150 ml during the day.

Possible Complications

Varicose veins of the stomach often lead to bleeding and iron deficiency anemia. This is due to the fact that the disease is diagnosed in the later stages.

Progression leads to the involvement of intestinal vessels in the pathological process. We must not forget that there is a risk of relapse, so even after surgical treatment of varicose veins, preventive measures should be observed.

Prevention

Prevention of the disease lies in the fact that a person must lead healthy lifestyle life - to play sports, organize a complete and balanced diet, get rid of bad habits.

Food restrictions and diet

Diet plays an important role in disease prevention. Proper nutrition with varicose veins of the stomach, it will help not only prevent the development of pathology, but also slow down the progression of existing ectasias.

A person should exclude spicy, fried, fatty and salty foods from the menu, give up alcohol, coffee and strong tea. It is necessary to limit the use of confectionery and bakery products. When preparing dishes, use high-quality and natural products, do not use hot spices, baking powder, flavorings and other harmful ingredients.

To strengthen the blood vessels, the patient's nutrition must be complete and balanced. You need to eat 4-5 times a day, in small portions.

Vegetable soups, okroshka, cereals, especially buckwheat, should be present in the daily diet. Have a positive effect on the state of the gastrointestinal tract dairy products, mild varieties of hard cheese, fresh vegetables and fruits. Dishes must be cooked in vegetable oil.

To improve blood circulation and prevent the progression of varicose veins will help the regular use of a small amount of fresh raspberries, chokeberry or red mountain ash, currants, grapes.

Home » Causes of varicose veins

Varicose veins of the stomach and lower esophagus is a disease characterized by a violation of the outflow of blood from the veins of these organs and a change in their structure (the vessels expand, become unnaturally looping, long and form knots).

Esophageal varicose veins, gastric varicose veins: causes

Usually, varicose veins in the stomach and esophagus occur due to a phenomenon called portal hypertension (increased pressure in the portal vein system), of various etiologies. The normal pressure in this blood vessel in the normal state does not exceed 6 mmHg. With an increase in this indicator to 12–20 mm Hg, there is a violation of the outflow of blood and varicose veins. Portal hypertension results from thrombosis or compression of the portal vein, gallstones, and certain disorders of the pancreas, stomach, and liver, including:

• Cirrhosis and chronic hepatitis;
• Echinococcosis;
• Polycystic;
• Fibrosis, including congenital;
• Sarcoidosis;
• Malignant and benign neoplasms;
• Aneurysms of the arteries of the spleen and liver.

This disease can be congenital or appear at any time in life, regardless of age. As a result of impaired venous circulation due to the listed diseases or for other reasons. Most often, the disease is a consequence of cirrhosis of the liver, since this pathology is characterized by a change in the structure of the organ, modification and growth of its tissues, which, as the disease progresses, first lead to a weakening and then a complete cessation of the liver.

Clinical picture of gastric varicose veins

At the beginning, the disease is almost asymptomatic, without causing any discomfort to the patient. Sometimes patients develop severe heartburn. This symptom, most often, goes unnoticed and does not serve as a reason for contacting a doctor. But even a doctor does not always associate heartburn with varicose veins of the digestive system. Therefore, the disease develops further and is complicated by bleeding, which is manifested by the following symptoms:

1. Ascites (accumulation of fluid in the abdominal cavity, in which the stomach increases in size).
2. Painless vomiting of blood, usually profuse.
3. Tachycardia (strong heartbeat).
4. Hypotension (low blood pressure).
5. In severe cases, hypovolemic shock.

Diagnostic methods for detecting the disease

At the initial stages, pathology can be detected only with the help of instrumental diagnostic methods. Patients may be given x-rays with a contrast agent (barium sulfate). The most accurate way to establish the disease is esophagogastroscopy (internal examination of the esophagus and stomach). It is necessary to conduct a study very carefully, trying not to cause injury that can provoke bleeding.

After identifying dilated veins, they must continue the examination to establish the causes of the pathology. Portal hypertension most often leads to a combined lesion of the veins, both the stomach and the esophagus. When stretching individual sections of the vessels, thrombosis of the vein of the spleen can be suspected. In rare cases, the cause of esophageal varices may lurk in eosinophilic gastroenteritis. As a result of damage to the intestinal mucosa, inflammation spreads to smooth muscles, then fibrosis (tissue growth) and intestinal obstruction join.

Since the disease can be caused by cancerous tumors, patients are often prescribed a histological examination.

The main stages of treatment

Unfortunately, most often the disease is detected as a result of internal bleeding, which can cause hypovolemic shock and even lead to death. In such cases, the patient requires urgent hospitalization and resuscitation. As soon as possible, you need to stop the bleeding and replenish the BCC.

After stabilization of the patient's condition, the treatment of the underlying disease and procedures aimed at reducing the pressure of the portal vein and preventing bleeding are performed.

Currently, the following main methods of solving the problem are used:

1. Sclerotherapy, which consists in the endoscopic injection of an adhesive solution into the vessels of the stomach or esophagus. This procedure is repeated, depending on the severity of the disease, once a week or a month, until a scar is formed.
2. Ligation of varicose veins using a rubber bandage. The method is superior in efficiency to sclerotherapy.
3. Intrahepatic shunting. Reducing pressure by inserting a stent under x-ray guidance into the mid-liver area to connect the hepatic and portal veins.
4. Splenorenal shunting. It is produced to prevent bleeding by combining the splenic vein and the vein of the left kidney with a shunt.
5. Medical treatment - application vasoconstrictor drugs(Vasopressin), nitrates to reduce pressure in the portal vein (Nitroglycerin), as well as Somatostatin (or its analogue Octreotide) to reduce the blood pressure of the internal organs and narrow the dilated vessels (taken for a long time).

Prevention of complications

In order to prevent the occurrence of life-threatening complications, in the form of profuse gastric bleeding from varicose veins, hemorrhage into the esophagus and stomach, acute liver failure, as well as ascites, a special regimen is required.

In diseases leading to portal hypertension, a sparing diet is indicated. You need to eat in small portions 4-6 times a day. You can not eat later than four hours before bedtime. Preference should be given to boiled or steamed foods. Too hot or cold food should be completely abandoned. It is necessary to prevent the entry of spicy and acidic foods into the esophagus.

Need to avoid high physical activity, gravity must be rolled, but in no case should it be lifted. You have to stop exercising in the gym.

If you have problems with the liver, you should immediately consult a doctor who will prescribe treatment in the early stages of the disease. With high portal pressure, the use of beta-blockers is recommended.

Phlebectasia or varicose veins of the stomach is a disease of a dangerous category, which is manifested by an increase in the volume of the gastric veins and the occurrence of blood clots in them. Pathology is insidious due to the asymptomatic course of the initial stage. The disease is quite serious, so it needs urgent treatment.

What is stomach varicose veins?

In the stomach, varicose veins are divided into 4 stages of development:

1. Symptoms do not appear, the expansion of the lumen of the vessels is single, so the patient has no complaints. Only endoscopy can reveal this degree.
2. The structures of the veins acquire a tortuous and uneven shape. In this case, the increase does not exceed 3 mm, and the narrowing of the gaps occurs at small intervals. Bleeding at this stage a rare event. An x-ray or endoscopy can detect the pathology.
3. There is a noticeable narrowing of the lumen of the veins, their swelling. The stage is characterized by the presence of nodes, narrowing of the tone of the walls. The main signs are already appearing, only their timely recognition is necessary, since the threat of hemorrhage at this stage increases significantly. Transferring therapy is prohibited.
4. The nodes are noticeably manifested, the gaps narrow, the gastric mucosa is thoroughly depleted. The divergence of a whole thread of damaged vessels from a large node is likely. Vessels are thinned to such an extent that the opening of a hemorrhage is likely at any time. If this happens, the patient is in danger.

It is important to highlight that the development of varicose veins of the stomach requires a significant period, for this reason, short-term compression of the veins by the neoplasm is not capable of provoking the occurrence of characteristic changes.

The disease is of the following types:

• acquired - appears in the case of an increase in pressure indicators in the portal vein. This vessel carries out the function of delivering blood to the liver. Difficulties are created by a failure in the movement of blood through this organ. Pathology makes the veins soft, brittle, with every chance of bursting at any moment;
• inherited - the disease is determined from birth. As a rule, the complex course of the period of bearing a child can be associated with a genetic predisposition.

Congenital varicose veins of the gastric veins are rare. Most often, doctors diagnose an acquired type of disease. Basically, the pathology affects patients over 50 years of age.

Varicose veins of the stomach causes development

Cirrhosis of the liver can cause varicose veins of the stomach

The main factor contributing to the onset of the disease is portal hypertension, which causes an increase in veins in digestive organ. Often, a similar condition is observed with cirrhosis of the liver due to the appearance of numerous scars on it. However, this is not the only condition for the occurrence of a dangerous disease. Other causes of pathology:

• liver diseases that cause disruptions in the movement of blood;
• thrombus formation;
• compression of the portal vein by neoplasms;
• cardiovascular failure.

With special attention to the diagnosis of varicose veins in the stomach, it is necessary to approach patients affected by cirrhosis of the liver and hepatitis. This is due to the greater vulnerability of the organs and can end badly.

Symptoms of the disease and diagnosis

In the early stages, phlebectasia is asymptomatic, which creates difficulties in determining the disease. Over time, the patient has the following signs of manifestation of pathology:

• Heaviness and discomfort in the chest area.
• An increase in the volume of the abdomen caused by the accumulation of fluid in the abdominal cavity.
• In the anterior lobe abdominal wall probably the outline of the "head of a jellyfish" - a pattern created by dilated veins.
• Difficulty breathing after physical activity.
• Increased heartburn not associated with eating.
• Failure of the swallowing reflex.

It is good when a person pays attention to these symptoms and consults a doctor. Diagnosis of the disease, due to the listed signs, will make it possible to carry out operational measures aimed at treating phlebectasia. However, visits to the doctor at this stage are rare. Usually, varicose veins of the gastric veins appear during rupture of blood vessels. At the beginning of the hemorrhage, the pathology picture acquires the following signs:

• vomiting, accompanied by bloody discharge (indicates the discovery of a hemorrhage in the stomach);
• drop in blood pressure;
• increased heart rate rhythms with failures;
• stomach ache;
• shock state.

At the first symptoms of the disease, consult a doctor for examination

Hemorrhage may occur small, although it is often manifested abundantly. It is urgent to start therapy due to the fact that the pathology can worsen or end in the death of the patient.

Diagnosis of phlebectasia is carried out through endoscopy, as well as studies to detect coagulopathy. Varicose veins are detected by x-ray examination of the upper sections digestive system with the introduction of contrast and angiography.

Preference is given to endoscopy - it provides identification of veins affected by varicose veins, their volume and establish hemorrhage in them. In patients with liver cirrhosis and phlebectasia, in 40% of cases they do not act as a source of hemorrhage. In such situations, bleeding is provoked by erosion and bleeding of the gastric mucosa tissues.

Endoscopy allows you to identify nodes with an increased risk of bleeding, even in the case of the confirmed presence of varicose veins. Due to the fact that the pathology occurs due to cirrhosis of the liver, it is necessary to find out the probable failures in blood clotting. Laboratory tests include blood tests taking into account the number of platelets, a characteristic of the liver.

Treatment of pathology

Since varicose veins of the stomach are not considered to be a spontaneously occurring disease, its therapy is not carried out. The use of certain medications makes it possible to reduce portal hypertension, so they are used in a complex, exclusively as prescribed by the doctor.

If it is possible to eliminate the cause of hypertension, appropriate treatment or surgery is carried out, in the majority of cases the only way to cure is liver transplantation.

Medical treatment is carried out using the following means:

1. Vasopressin - normalizes the state of constricted veins.
2. Nitrates included in Nitroglycerin due to a decrease in pressure in the portal vein.
3. Somatostatin or Okreotide - reduce the blood pressure of the internal organs.

Help is provided at the onset of a hemorrhage, for which a Blackmore probe is inserted into the alimentary tract, whereby vein compression is performed and bleeding stops. At the same time, treatment is performed to increase blood clotting.

Phlebectasia becomes a severe exacerbation of portal hypertension due to the fact that at one stage or another it provokes the formation of gastrointestinal hemorrhage, accompanied by the loss of a large volume of blood and threatening life.

In parallel with this, help with bleeding still remains symptomatic, and complete therapy provides for the elimination of portal hypertension directly. This is not permissible in every case, for this reason, the prevention of both portal hypertension and phlebectasia is of particular importance, because it is very difficult to overcome the existing violations.

A dangerous and common disease, varicose veins affect any part of the body. circulatory system. Localization in the area of ​​internal organs is one of the variants of manifestation.

If a person has noticed digestive disorders in himself, can varicose veins of the stomach be their cause? Such a possibility exists, unfortunately. The doctor will make the correct diagnosis, but the time for diagnosis will be significantly reduced if the symptoms are clearly described.

Sometimes it's better to play it safe, check for signs this disease, time analyzes all the same to hand over it is necessary. Many people consider the methods of examination of the gastrointestinal tract unpleasant, they do not seek to undergo them once again. Knowing the main signs, finding them in yourself, you can save time, nerves, money, take an interest, ask a doctor, how be in this situation.

What is varicose veins? This term is familiar to almost everyone today. This disease is associated with severe psychological discomfort. Its manifestations spoil the appearance, change habits, preferences in clothing, style, limit self-expression, cause physical discomfort in the future.

Varicose veins of the stomach are pathological changes blood vessels, their increase, the appearance of nodes, loops, the formation of blood clots in this internal organ. The blood supply worsens, respectively, the condition of the tissues worsens. The process of digestion is also disturbed at the same time.

In the initial stages, there are practically no symptoms. Therefore, the diagnosis is usually made in the later stages. The first sign is heartburn or belching. But they don't pay attention to her. Then, when heartburn or belching often worries, you should listen to yourself, your state of health.

It might be time to see a doctor. Functional disorders, which appeared in connection with circumstances, situational, are characterized by transience, pathological - by stability. With the deformation of blood vessels, doctors do not always associate heartburn, belching, they look for reasons elsewhere. And yet, there is a possibility that this is varicose veins of the stomach.

Later symptoms include bleeding. You can notice it by changes in the color of the feces - it is almost black if it contains blood. The urge to vomit begins to disturb. They cannot be eliminated by changing the nutrition system, eating foods that normalize digestion.

Vomiting becomes a constant need. The vomit contains a large amount of pink mucus. Sometimes it contains blood clots. In the abdominal cavity, they become noticeable pain. The cardiovascular system begins to work worse. A person notices that something is wrong with his pressure, heart rate.

Who is at risk

This disease, according to statistics, is more common in men. What explains such statistics, scientists do not know exactly. Possibly anatomical and physiological features gender. A woman must bear a child, and pregnancy due to upright posture can slightly affect the abdominal organs. The woman's body is more resistant to deformations of different tissues in this area. The natural mechanisms of self-regulation also protect the blood vessels of the stomach from stretching. This is probably the reason.

Varicose veins are classified as genetically determined diseases. Among the causes of the development of pathology are the systematic use of alcohol in large quantities, an unbalanced diet, the frequent consumption of foods high in cholesterol, the use of drugs in in large numbers, weight lifting, chronic diseases of the digestive system.

After age 50, the risk of developing pathology increases. There is a relationship between its appearance and general health. In particular, people suffering chronic diseases liver, pancreas, heart or stomach are at risk. There is a high chance that this problem will also occur. Portal hypertension is a critical factor.

Diagnosis of the disease

What tests are needed to make a diagnosis? Suspicions only inspire anxiety, anxiety, become an additional burden on the nervous and cardiovascular systems. Is it possible to get rid of them? Modern equipment will help to obtain comprehensive information.

The following tests are usually given:

• esophagogastroscopy;
• radiography with contrast;
• Ultrasound of the abdominal organs;
• general blood analysis;
• an extended blood test aimed at detecting coagulopathy;
• liver function tests.

Pathological deformation of the veins of the stomach is often combined with changes in the veins of the esophagus. But varicose veins in other organs appear for a reason. If it is found in the stomach of a person, this does not mean that it should be expected to appear in the esophagus. The lesion is a weak point, a gap in the shell of health. Therefore, the spread of deformations throughout the body is extremely rare.

The disease does not pose a threat to life. However, it reduces its duration, affects its quality. Severe bleeding, which is highly likely if the problem is not treated, will stop on its own. Doctors only help to avoid complications and prescribe those drugs that suit the patient as much as possible, taking into account the clinical picture and individual characteristics. Varicose veins of the stomach and the disorders that made its development possible in the later stages cause discomfort, prevent a person from living a full life.

Modern methods of treatment

Efficiency modern methods treatment is proven, tested, although a lot of work is still ahead. Even if we are talking about a genetic predisposition, conditionality, it is possible to control the state of health. Surgery is a radical method. It is relevant only when classical therapy does not give results.

Endoscopic ligation is a minimally invasive method that gives good results. In some cases, gastric vein bypass surgery is relevant. Sclerotherapy helps eliminate deformities. development stage, individual characteristics, clinical picture defines the best option treatment. The risk of relapse always remains. It takes a long time to treat this pathology, you need patience and perseverance, as well as optimism. Only in this case, you can count on recovery.

Diet is part of therapy

The diet is always prescribed. It is necessary to comply with it. The condition of the heart, blood vessels, blood and endocrine glands involved in the process of digestion will improve if the nutrients necessary for their normal functioning come with the products.

Be sure to reduce portions of food consumed - the walls of the stomach should not stretch much. This contributes to the deformation of the veins. It is better to eat more often, but little by little. It is advisable to divide the daily ration into 5-6 receptions and start the meal at the same time. The load in this case will decrease, become predictable, uniform.

Dishes rich in bad cholesterol should be excluded from the diet, steamed, baked, boiled. Fried food is its main source. Its use should be kept to a minimum. It is advisable to abandon it once and for all. Smoked meats, pickled, spicy, sour foods should also be excluded. Hot and cold food, drinks are bad for digestion. The optimum temperature is 37-45 degrees. Dinner is worth 3-4 hours before bedtime.

Alternative Medicine Methods

Treatment folk remedies It is aimed at the gradual harmonization of all functions in the body, strengthening the heart, circulatory and digestive systems. It is necessary to normalize physical activity - walk more, go jogging, swimming. But activity above normal is contraindicated.

What is normal activity? What are the criteria for determining the optimal voltage level? The desire to move less often appears in a person suffering from varicose veins of the stomach. This negative trend should be controlled by willpower, consciously, rationalized, and a bad mood should be distinguished from apathy, despondency, fatigue from the onset of symptoms. Bad feeling unacceptable. And yet, after the first, second, third run, for example, you can feel a breakdown, and not a surge of vivacity. It should be taken responsibly to increase muscle tone.

Violations of pressure adversely affect the state of the heart muscle. Blood clots often appear with this disease, which is a sign of a deterioration in the state of the cardiovascular system as a whole. With a minimum of effort, but regularly, systematically, you can get a good result.

The less a person moves, the less useful substances, oxygen enters cells and tissues. Blood circulation, metabolic processes slow down. Toxins also cease to be excreted in the right amount, in a timely manner. A lot of energy the body will spend on fighting these negative tendencies. The goal is to direct energy in a constructive, constructive direction, to strengthen the body, regenerate, recover, and reduce the likelihood of a worsening situation.

It has long been known that cold douches, cold and hot shower helps to improve the condition of the circulatory system. Such procedures normalize blood pressure, contribute to the harmonious distribution of blood. This is a positive stress for the autonomic nervous system, which controls the contraction of the walls of blood vessels.

Used for treatment and medicinal plants. You have to drink their decoctions. Chamomile flowers, verbina leaves, hop cones, sage are used. They act delicately, do not contradict traditional therapy.

Some more news:

Causes of esophageal varicose veins

Varicose veins of the esophagus can be acquired or be a congenital pathology. The acquired form appears more often and develops against the background of portal hypertension. The condition is characterized by excess pressure in the portal vein, which is responsible for blood circulation from the organs to the liver. Portal hypertension provokes thinning of the venous walls with an increased risk of opening internal bleeding. The direct cause of the development of the disease is the blockage of the blood supply.

The provoking factors for the appearance of varix are:

Stable hypertension can cause destruction of the vascular structure in the esophagus.

• liver pathology - cirrhosis, hepatitis, tuberculosis, etc.;
• vascular thrombosis;
• consistently high blood pressure;
• thrombophlebitis (Chiari syndrome);
• compression of the portal vein by tumor or cystic formations, enlarged lymph nodes, gallstones.

Upper varicose veins of the esophagus are provoked by such reasons:

• malignant goiter;
• benign tumor (angioma);
• vascular problems in Rendu-Osler syndrome.

Less commonly, esophageal varicose veins develop against a background of chronically impaired blood circulation due to cardiovascular insufficiency. Most often, pathology occurs in men aged 50 years and older.. The reasons for the congenital form have not been elucidated.

Symptoms

Pathology in most cases proceeds without visible symptoms. The first clear signs appear when bleeding from the esophagus opens. When the blood flow is obstructed, the veins begin to unbalancedly expand in the form of nodules, lengthen, and become tortuosity. Due to the thinning of the walls, they rupture, which leads to esophageal bleeding.

Sometimes signs of venous expansion of the esophagus develop rapidly, like the pathology itself, but more often the disease proceeds very slowly, not manifesting itself for many years.

Initial symptoms and harbingers of bleeding are:

• indistinct pain and heaviness in the chest;
• severe heartburn with frequent belching;
• difficulty swallowing dry food.

Varicose veins in the esophagus are accompanied by the release of blood to the outside, dizziness, weakness.

Symptoms are associated with dysfunction of the esophagus, slight narrowing of the lumen, acid reflux from the stomach.

The main manifestation of varix is ​​acute bleeding, in which the following symptoms are observed:

• bloody vomiting of dark red color;
• liquefaction of tarry stools;
• increasing pallor of the skin, when the blood flows without stopping;
• dizziness;
• malaise and weakness.

Chronic blood loss develops if the enlarged section of the vein bleeds constantly. The condition is characterized by the following symptoms:

• symptoms of hypochromic anemia;
• general weakness;
• adynamia;
• shortness of breath;
• pallor;
• severe weight loss;
• chalky.

The more abundant the hemorrhage, the brighter and more intense the clinical picture develops and the risk of death increases. According to statistics, if the esophagus constantly bleeds, 4 out of 5 cases end in death. This can be prevented by timely urgent care. Therefore, early diagnosis and drastic measures are extremely important.

Types and degrees of varicose veins

Varicose veins in the esophagus can be without hemorrhage.

Varieties of VRV of the esophagus differ in the size of the expansion of the veins, their features and visual symptoms, which are determined by esophagoscopy. When classifying, the causes that provoked the pathology are taken into account.

Varicose veins of the esophagus are of 2 varieties:

• without blood loss;
• with bleeding.

According to the form, there is:

• congenital, accompanied by background pathologies and characterized by unclear pathogenesis;
• an acquired disease that has arisen against the background of adverse effects of the external and internal environment.

By degree

• I. - the diameter of the lumen of direct vessels does not exceed 0.5 cm, which do not go into the gastric tissues;
• II. - the diameter reaches 1 cm, tortuosity is acquired, the upper section reaches the middle of the lumen;
• III. - the portal vein expands by more than 1 cm, with strong tension, thinning, tightness, tortuosity of the walls, on which red dots appear.

Varicose veins of the stomach

Varicose veins in the digestive organs can be with extensive damage to the veins, with more than 1 cm, and several mm.

There are different types of pathology venous expansion in the esophagus and stomach:

• I. - diameter of vessels up to 0.5 cm, which are not visible on the gastric mucosa;
• II. - solitary-polypoid portal vasodilation of 1 cm;
• III. - nodular-polypoid expansion of more than 1 cm.

According to Vitenasom and Tamulevichiute

There are 4 stages:

• I. vessel diameter - 0.2-0.3 cm, which are bluish, but straight;
• II. knotty, uneven, tortuous veins with a diameter of more than 0.3 cm;
  III. distinct nodes, tortuosity, protrusion into the esophageal lumen up to the gastric vault;
• IV. grape-shaped, polypoid vessels that cover or significantly narrow the lumen of the esophagus, while on the mucous membrane enveloping the node, a thin network of small capillaries is formed, which provokes secondary varicose veins.

NCH ​​RAMS

There are three stages of the disease:

• I. vessel with a diameter of 0.2-0.3 cm;
• II. 0.3-0.5 cm;
• III. over 0.5 cm.

Zdenek Marzatka

The division is carried out into 3 degrees:

• I. longitudinal vessels, slightly elevated above the mucosa;
• II. dilated, tortuous veins;
• III. veins of the pseudotumor type.

Diagnostics

Vascular pathologies in the internal organs can only be detected by a hardware study.

It is possible to determine the dilated veins of the esophagus only with a hardware method, since visible symptoms are often absent. Usually assigned:

• all types of plasma studies - to determine the patient's condition;
• functional and liver tests - for the study of coagulopathy;
• Ultrasound and radiography - to clarify the prediagnosis;
• fibroesophagoscopy - to determine the causes of blood loss.

If there are background pathologies, an additional examination is performed to determine the cause of their development.

Traditional treatment

Regardless of the severity of varicose veins, the disease is considered incurable. But it cannot be ignored, since late diagnosis and identification of causes, untimely emergency care or improper therapy can lead to death.

Treatment of esophageal varicose veins is complex, complex, combining conservative, medical and surgical (with late detection) therapy.

Diet, exclusion of bad habits, exercise control is a prerequisite for restoring the integrity of the veins in the esophagus.

conservative approach

The methodology is based on the following rules:

• adherence to strict diet therapy and diet;
• minimization of physical activity;
• exclusion of bad habits;
• strict adherence to the recommendations of the doctor.

Endoscopy

Today, phlebectasia of the esophagus is treated with a minimally invasive technique, especially if esophageal bleeding is detected. To stop blood loss during the operation, sclerosants with different principles of action are used. Endoscopic treatment performed using three techniques:

Extensive damage to the vessels in the esophagus and stomach is desirable to eliminate surgery.

1. Intravasal approach, when connective tissue is created in a thrombosed varicose nodule. The disadvantage is a large number of complications, for example, the probe is able to pierce the esophageal wall, which will lead to purulent-necrotic thrombophlebitis.
2. Paravasal approach, when the sclerosant is injected into the submucosal layer with further scarring of the fiber and compression of the wide veins. Advantages - a minimum of complications during an endoscopically sparing procedure.
3. Ligation of the veins of the esophagus, when sources of bleeding are cauterized in order to stop blood loss. Then, when doping, latex rings are put on the problem area. The advantage is that hemostasis is achieved in 90% of patients.

Balloon tamponade

The method involves squeezing the problem area with a special probe equipped with a balloon. Stopping bleeding from varicose veins of the esophagus occurs with an increase in the diameter of the balloon in the stomach with traction of the esophageal device without inflation. Such a stop of blood loss is considered dangerous, is rarely used, and provokes various complications. But the effectiveness of treatment is 90%.

Operation

Varicose veins of the esophagus are often treated with sclerosis. The essence of the method:

Even when operating on damaged vessels in the digestive organs, relapses and repeated surgery are not ruled out.

1. introduction into the affected vein and the lumen of a special solution;
2. repetition of manipulation after 5, 30, 90 days.

A stable effect is achieved when the procedure is performed 4 times a year.

Other techniques used:

• shunting, when an intrahepatic stent is inserted connecting the portal and hepatic veins;
• anastomosis, when a connecting bridge is created to bypass the problem area;
• sheathing of veins (alloying with tying vessels with 1-3 elastic rings or nylon loops);
• devascularization, when the affected vessels are excised and replaced with a prosthesis.

Medicines

Drug therapy is aimed at reducing the negative impact on the walls of the veins. For this purpose:

• drugs to reduce the acidity of gastric juice;
• astringent preparations;
• multivitamin complexes.

Folk remedies

You can smooth out varicose veins in the esophagus by taking infusions from medicinal herbs and berries.

Treatment of esophageal varix is ​​possible with folk remedies at home. Popular recipes:

1. 1 st. l. Japanese Sophora insist in 250 ml of boiling water. Drink tea throughout the day for 4 approaches. The course of treatment is up to 3 months.
2. 1 st. l. crushed fruits of mountain ash and rose hips are boiled over a fire in 500 ml of water with a 5-minute boil. Drink all day 100 ml.

The choice of a treatment regimen with folk remedies should be agreed with the doctor.

Diet

Principles of diet therapy for varicose veins of the esophagus:

1. stable nutrition at the same time;
2. fragmentation of meals in small portions - up to 6 rubles / day;
3. last snack - no later than 3 hours before going to bed;
4. use boiling, stewing, baking, steaming as a heat treatment of food;
5. the absorbed food should be at room temperature and a puree or liquid consistency;
6. exclusion of bad habits.

Unauthorized Products

In case of injuries of the veins in the esophagus, it is necessary to exclude hard foods from the diet, as well as fried, spicy, starchy foods, alcoholic drinks and strong hot drinks.

Varicose veins of the esophagus involves the rejection of such food:

• baking, sweets, sugar;
• spicy sauces, seasonings;
• pasta, bread and other pastries;
• spicy, sour, oversalted, nutritious and fried meat dishes.

You can not drink:

• alcoholic drinks;
• strong black tea;
• coffee.

Approved Products

You need to include in your diet:

• food with vitamin E: greens, lettuce, egg yolk, oil from corn and sunflower;
• foods with vitamin C: citrus fruits, berries, potatoes, peppers;
• with bioflavonoids: cherry, sweet cherry;
• with routine: nuts, grapefruit, green tea, black currant;
• With vegetable fibers: fresh vegetables with fruits, legumes.

It is necessary to increase the amount of low-fat broths and soups consumed, cereals on water with dilution of milk, compotes. At the same time, it is important to ensure an abundant drinking regime with the consumption of 1 liter of water per day, not including other liquids.

Prevention

Take care of the general improvement of the body in order to prevent vascular pathology in the digestive organs.

The purpose of preventive measures is to maintain the normal state of blood vessels. For this:

• it is important to monitor the condition of the liver;
• follow the doctor's recommendations;
• timely treat pathologies;
• regulate high blood pressure;
• lead a healthy lifestyle without bad habits;
• eat right and follow the regime;
• harden, massage and perform light exercises to strengthen the body;
• take multivitamins.

Complications

The most serious consequence of esophageal varix syndrome is hidden or massive hemorrhage. The causes of rupture of the vessels of the esophagus are as follows:

• straining;
• jump in blood pressure;
• sharp lifting of weights;
• prolonged fever;
• peptic ulcers in the esophagus;
• collapsing tumor;
• Mallory-Weiss syndrome with a sharp perforation of the mucosa in the pericardial zone against the background of severe vomiting.

Untreated vessels in the esophagus can lead to death.

Harbingers of blood loss are:

• slight tickling in the throat;
• salty taste on the tongue.

After the onset of these symptoms:

• severe vomiting develops - scarlet or dark;
• the innervation of the esophagus and its blood supply are disturbed.

Forecast

Varicose veins of the esophagus are characterized by high mortality - more than 50%. The outcome of the disease depends on the cause of its cause, mainly on the type and severity of liver pathology. With a normally functioning liver in 80% of patients, blood loss is eliminated on its own. In 75% of survivors after a complication, a relapse occurs within the first 12-24 months. It is possible to reduce the risk with regular treatment of venous syndrome with medications and endoscopically.

More about phlebectasia

The name of the problem speaks for itself - with varicose veins in the stomach or esophagus, their increase is observed, which leads to protrusion of the walls. Something like knots appear on the vessels.

The disease can be of two types:

• Acquired - develops with increased pressure in the portal vein. This vein is responsible for supplying blood to the liver. This problem leads to a violation of blood flow through the liver. In this case, the veins become tender, brittle and can break literally at any moment.
• Congenital - the disease is diagnosed from the moment of birth. Usually associated with a genetic predisposition, it can be triggered by a severe course of pregnancy.

Congenital esophageal varices are rare. In most situations, doctors diagnose an acquired form of the disease. This is mainly a problem for patients over 50 years of age.

Varicose veins of the stomach - the causes of the disease

The main cause of gastric varicose veins is portal hypertension, which causes the veins in the esophagus to swell. Often this condition is observed with cirrhosis of the liver, as many scars appear on it. But this is not the only reason for the manifestation of an unpleasant disease.

There are other reasons that can cause the disease:

• Diseases of the liver that provoke a violation of blood flow.
• The appearance of thrombi.
• Squeezing tumors of the rotary vein.
• Vascular and heart failure.

Particular attention should be paid to diagnosing the likelihood of venous disease in patients suffering from cirrhosis of the liver and hepatitis. Since these organs become even more vulnerable and untimely treatment can lead to negative consequences.

Signs of the disease

At the initial stage of the disease, there are no specific symptoms. Therefore, it is difficult to determine the problem. But as the problem develops, the patient has certain signs of phlebectasia.

• severity and discomfort in the chest.
• Enlargement of the abdomen due to the accumulation of fluid in the abdominal cavity.
• In the front of the abdominal wall, the "head of a jellyfish", as it is called, can be drawn. This is a drawing of veins dilated in the esophagus.
• Shortness of breath due to activity.
• Severe heartburn regardless of food intake.
• Swallowing dysfunction.

It is great if the patient pays attention to the listed signs and consults a doctor. Diagnosis of the disease, based on these symptoms, will allow you to take urgent measures to treat gastric varicose veins. But situations when patients come to the doctor at this stage are rare. Most often, phlebectasia manifests itself already at the time of rupture of the veins. When bleeding starts, the signs of the problem become more pronounced.

• Vomiting with bloody discharge.
• Black color of feces, as well as noticeable impurities of blood in it.
• Lowering blood pressure.
• Cardiopalmus.
• Shock state.

Bleeding with varicose veins can be minor, but most often it is massive. Treatment must be started urgently, as the problem can lead to a serious deterioration in the condition or death.

The degree of varicose veins of the stomach and the diagnosis of the disease

In total, there are four degrees of varicose veins of the stomach or esophagus.

• Degree 1- no symptoms are observed, vein ectasias are single, which does not prevent the patient from feeling great. To determine the first degree of the disease is possible only with the help of endoscopy.
• Degree 2- vascular structures become tortuous and uneven. But at the same time, the swelling does not exceed 3 mm, and the gaps narrow to insignificant distances. In this case, bleeding is rare. It is also possible to establish the problem mainly with the help of x-rays or endoscopy. Symptoms are not expressed.
• Degree 3- the venous lumen noticeably narrows, the veins bulge. At this stage, the nodes are clearly visible, the tone of the walls narrows. The main symptoms are already manifesting, it remains only to notice them in time, since the risk of bleeding at this stage of the disease increases markedly. It is impossible to postpone treatment at the third stage.
• Degree 4- the nodes are clearly visible, the gaps are narrowed, the gastric mucosa is seriously thinned. A whole string of affected vessels can diverge from a large knot. All of them are thinned so that bleeding can open at any moment. If this happens, the patient is in serious danger.

To diagnose venous disease and determine its degree, doctors use different research methods:

• Laboratory studies of blood, urine and feces.
• Ultrasound of the abdominal organs.
• Esophagoscopy.
• X-ray studies.

Treatment Methods

With varicose veins of the esophagus or stomach, a competent approach is needed. After determining the degree of the disease, it is important to find the causes of the development of pathology. The doctor prescribes the necessary medications that help strengthen the liver and blood vessels. Also, the patient is advised to adhere to a diet and not give up physical activity.

Medications for varicose veins of the stomach are prescribed mainly as follows:

• Drugs, the action of which is aimed at constricting blood vessels and stopping bleeding.
• colloidal solutions.
• Astringents.
• Antacids.
• Vitamins.

Conservative therapy with prescription medicines- the process is lengthy. It is considered more efficient surgical intervention. It helps to quickly improve the patient's condition by electrocoagulation of damaged vessels and squeezing them during bleeding, which is carried out using a special probe.

Unfortunately, no matter what methods of treatment are undertaken, it is impossible to cure the disease. Therefore, all measures are aimed solely at preventing the further development of pathology. In the first stages, maintaining the condition of the esophagus and stomach is much easier than in the third and fourth stages of the disease. And the appearance of bleeding further worsens the prognosis.

Causes of the expansion of the veins of the esophagus

The main symptom of any vascular disease The esophagus is almost always a symptom of esophageal bleeding. These bleedings can occur when the esophagus and a nearby large vessel are injured, for example, when a large foreign body with sharp and cutting edges is fixed in the esophagus; when a tumor of the esophagus grows into any large vessel of the mediastinum and breaks through it, for example, into the descending part of the aorta. Most often, bleeding from the vessels of the esophagus itself is observed when its wall is damaged by a hard esophagoscope, a sharp foreign body, vessel erosion by an ulcerative process, or decay

Varicose veins of the stomach are less common than similar pathologies in other organs. The disease requires specialized care - in order to prevent the rapid development of complications and save the patient's life.

What is stomach varicose veins

Phlebectasia is characterized by an increase in the volume of the venous vessels of the organ and the formation of blood clots in them. The initial stages of the development of the disease do not have symptomatic manifestations, which increases its danger. There are certain causes of the pathological process - from genetic abnormalities to cirrhosis of the liver.

Features of the disease

Experts divide the disease into four successive stages of progression:

1. The clinical picture does not have pronounced symptomatic manifestations, changes in the lumen of blood vessels are single. Patients do not complain about the deterioration of the condition, the problem is diagnosed with the help of endoscopy.
2. Differs in tortuosity and unevenness of veins. General indicators of increase do not exceed 3 mm, narrowing occurs for short periods of time. In cases of exclusion, spontaneous bleeding may occur.
3. It is characterized by a noticeable decrease in vascular lumens, their swelling. When diagnosing, nodes and a decrease in the tone of the walls are detected. Symptomatic manifestations are present, the likelihood of bleeding increases.
4. It is determined by a significant depletion of the mucous membranes of the stomach, a pronounced narrowing of the lumens and prominent nodes. Damaged small veins diverge from a large node - their condition can provoke bleeding at any time.

The formation of varicose veins takes significant periods of time - periodic squeezing gradually leads to the appearance of characteristic changes.

Secondary division reports on the factors of its formation:

• acquired variant - occurs when increased rates pressure in the portal vessel responsible for the supply of blood to the liver, as the pathology increases, the veins become soft, increased fragility, a violation of their integrity can occur at any second;
• hereditary - the pathological process is detected from the moment of birth, can be formed as a genetic predisposition or aggravated pregnancy;
• congenital - refers to rare formations.

In most cases, the acquired version of varicose lesions of the venous vessels of the stomach is diagnosed.

Causes

The main source of occurrence pathological condition is a portal form of hypertension, provoking an increase in veins in the digestive organ. Sometimes the problem is formed against the background of cirrhosis of the liver - as a consequence of the multiplicity of scars. Less common causes of the disease include:

• pathologies of the liver, causing disturbances in the circulation of blood flow;
• the formation of blood clots in the venous vessels;
• squeezing of the portal vein by a tumor-like process;
• insufficient performance of the cardiovascular department.

In the case of a history of hepatitis and cirrhosis of the liver, it is necessary to visit more often preventive examinations gastroenterologist - to capture the disease at the initial stages of occurrence. The stomach under the negative influence of these factors becomes vulnerable and easily exposed to the disease.

Who is at risk

The average data indicate that the majority of cases belong to certain subgroups:

• gender - the male sex is more likely to suffer from varicose veins of the stomach;
• age period - the problem is diagnosed after the 50th anniversary;
• concomitant diseases - in the presence of ailments of the liver, pancreas, heart muscle and liver.

Patients with cirrhosis are especially distinguished - according to clinical research Only one person in ten is not sick.

Clinical picture of gastric varicose veins

The initial stages of phlebectasia do not have obvious symptomatic manifestations, which makes it difficult to correctly determine the diagnosis. The gradual progression of the disease gives rise to clear clinical signs:

• feeling of discomfort and heaviness in the area of ​​the thoracic region;
• an increase in the volume of the abdominal cavity - due to the fluid accumulating in it;
• dilated venous vessels lead to the formation of a jellyfish head - a symptom characterized by the creation of a pattern from enlarged veins;
• problems with free breathing after physical or motor activity;
• spontaneous heartburn, not dependent on food intake;
• swallowing problems.

At this stage of formation, rare patients pay attention to the problem and seek a consultation with a gastroenterologist. Most patients come after a rupture of thinned blood vessels. The reason for the visit is the growing clinical picture:

• vomiting interspersed with blood particles;
• decrease in blood pressure;
• accelerated heartbeat with disturbed rhythm of contractions;
• pain in the epigastric region and other parts of the abdomen;
• state of shock.

Violation of the integrity of the vessels can cause both minor hemorrhage and massive. The patient needs emergency surgical care - in case of inaction, the disease will turn into a fatal outcome.

Diagnostic measures

When contacting the clinic, the patient is referred for a consultation with a gastroenterologist. The doctor collects an anamnesis: the time of occurrence of negative manifestations, the patient's personal feelings, existing diseases. Visual examination with palpation examination allows you to make a preliminary diagnosis.

For confirmation, the patient is sent for separate laboratory and instrumental examinations:

• all options for blood tests - to identify hidden inflammatory processes and other deviations;
• study of blood coagulation indicators;
• Ultrasound - the technique allows you to determine the altered blood vessels;
• fibroesophagoscopy - with the help of the apparatus, the stomach, the condition of the mucous membranes are thoroughly examined, places of violation of the integrity of the vessels are revealed.

If concomitant diseases are detected, the patient is sent for additional diagnostics in order to identify the causes of their formation.

Modern methods of treatment

Varicose lesions of the gastric veins do not belong to independent diseases and do not require specific therapy. Portal hypertension, as one of the causes of the development of the pathological process, is stopped with the help of certain medications that are recommended by the attending physician.

If there are prerequisites for its elimination, conservative therapy or surgical intervention may be prescribed. Most cases of gastric varicose veins require a donor liver transplant.

Medicinal direction - includes the following subgroups of drugs:

• vasodilators - to increase the lumen of blood vessels;
• hypertensive - to stabilize the level of blood pressure;
• nitrates - to improve the functionality of the portal vein, lowering pressure.

In addition to these drugs, colloidal solutions, multivitamin complexes, antacids and astringents are widely used.

Surgical direction - is carried out using three main methods:

1. Ligation of problematic veins - during the manipulation, a specialized rubber bandage is used. The technique is considered highly effective.
2. Shunting of the intrahepatic departments - is prescribed to reduce blood pressure. The main goal of the technique is to create a connection between the portal and the hepatic vessel.
3. Splenorenal shunting - involves the union of the veins of the left kidney and spleen with a shunt. Produced for prophylactic purposes - to prevent spontaneous bleeding.

Dietary - is included in the mandatory comprehensive program for the treatment of varicose lesions of the gastric vessels. The dietary requirements are as follows:

• frequent meals in small volumes - up to 6 times a day;
• last dinner - no less than three hours before a night's rest;
• enrichment of the daily menu with products with a sufficient content of useful elements;
• a sufficient amount of incoming liquid volumes - up to two and a half liters;
• a ban on alcoholic, low-alcohol products, tea, coffee, sweets, seasonings and spices, pastries.

Dishes are served warm. Allows you to cook by boiling, stewing, baking or steaming.

Folk remedies

Home recipes do not have a pronounced effect on varicose veins - most cases require surgical intervention. The use of folk methods is agreed with the attending physician. Commonly used medicines by traditional healers include:

• a large spoonful of Japanese sophora is brewed in a glass of boiling water, consumed four times a day, the total course of treatment should not exceed two months;
• rose hips and red rowan are taken in equal volumes - a large spoonful, poured with half a liter of liquid, boiled for five minutes, cooled and consumed in half a glass during the day.

Possible complications of pathology

The problematic complications of varicose veins in the stomach include spontaneous bleeding. They can arise from any reason - a thinned mucosa cannot create a full-fledged barrier.

The level of bleeding, the frequency of occurrence affect the final condition of the patient. In pathology, patients experience constant vomiting and a chronic lack of iron ions.

Prevention measures

To prevent the onset of the disease, it is necessary to follow the recommendations of doctors:

• monitor liver health;
• comply with all instructions of specialists;
• stabilize the level of blood pressure;
• avoid excessive addiction to alcohol, nicotine and drugs;
• switch to a healthy diet;
• carry out vitamin therapy;
• reduce the amount of lifting heavy objects.

To maintain the functionality of the gastrointestinal tract, you must adhere to the above tips.

Prognosis of varicose veins of the stomach and lower esophagus

The pathological process is characterized by a high level of mortality due to complications and concomitant diseases. Progressive cirrhosis can cause complicated bleeding.

The probability of recurrence of the disease varies between 55-75%. Mortality rate in the absence emergency assistance is within 50%.

The defeat of the gastric veins is a long process. In the initial phases of the disease, it can be stopped by protecting the body from spontaneous ruptures of blood vessels. The degree of damage to the vein wall is a predetermining factor for making a probable prognosis.

Varicose veins are currently a widespread pathology and one of the main causes of early onset of disability. Although most patients experience the development of this disease in the pelvic area and lower extremities, varicose veins of the esophagus is one of the extremely dangerous manifestations of this vascular lesion. Deformation of the veins supplying blood to the upper parts of the digestive tract rarely occurs as an independent pathological process. Such an anomaly can occur in a patient mainly as clinical manifestation violations of the functioning of various organs and systems of the human body.

In the medical environment, the term “phlebectasia” is widespread, which says little to the average layman. With this Latin expression, specialists refer to the deformation and change in the function of the walls of the vessels that supply the esophagus and stomach with blood.

The trigger mechanism for the development of such a pathology, doctors consider an increase in pressure in the portal vein, which is one of the main human blood vessels. A change in the throughput of this highway leads to stagnation in the vessels of the esophagus and stomach, which is the main reason for the change in the extensibility of their walls.

The mucous membrane covering the muscle layer becomes inflamed, knots and bulges appear in the veins, which in turn increases blood stasis and leads to malnutrition of the cells of the digestive system. Quite often, this process of restructuring takes long time and proceeds without external manifestations. It is the erased picture of the disease that is the main threat to the patient.

The main causes of occurrence

If a patient is diagnosed with esophageal varicose veins, the causes of such a problem may be the following:

• Inflammatory diseases of the liver, cirrhosis and oncological diseases that cause changes in the hepatic vessels and the affected organ itself.

• Foreign bodies in the liver and bile ducts. These include major malignancies and benign tumors, gallbladder stones. These formations block the portal vein and increase blood stasis in the vessels of the esophagus.
• Varicose veins of the esophagus and stomach can be caused by acute thrombosis outlet sections of the portal vein system. This may be the result of a bleeding disorder in the patient, diabetes and other pathologies.

All such disorders lead to development, without which the occurrence of esophageal varicose veins is unlikely.

Changes in the vascular wall of the digestive organs can also be a consequence of cardiovascular insufficiency, however, in this case, the clinic of the disease is different: pathology in the vessels is detected throughout the esophagus and stomach. With liver damage, the main process occurs in the area in the lower third of the esophagus and the cardial section of the stomach. The nodes themselves with portal hypertension will be much larger.

Symptoms typical of esophageal varicose veins

It should be noted that men are affected by this pathology 3 times more often than women. The main age of patients ranges from 45 to 55 years, which allows you to clearly define the risk group for the development of varicose veins. This is due to the fact that the representatives of the stronger sex are more susceptible to various concomitant factors, for example, frequent drinking, smoking, nervous stress, heavy physical labor.

As noted above, quite often there are no obvious signs of the disease for a long time, and the first manifestations of the disease appear when the patient develops one of the complications of varicose veins - inflammation of the esophageal mucosa or esophagitis.

For the initial diagnosis of varicose veins of the esophagus, the symptoms show the following:

• the patient is disturbed by digestive disorders in the form of heartburn and belching while eating;
• with the development of the process, many patients note difficulty in swallowing food, pain and heaviness in the epigastric region.

Similar manifestations of the disease are associated with swelling of the esophageal mucosa and a decrease in its lumen. And since the region of the esophagus and stomach is abundantly supplied with nerve endings vagus nerve, then the patient may develop cardiac arrhythmias and tachycardia.

Bleeding from dilated veins of the esophagus

In addition to inflammation of the mucous walls of the esophagus and stomach, difficulties in eating and constant dyspeptic symptoms, a similar pathology vascular wall risk of bleeding. Violation of trophism causes fragility of the walls of blood vessels, they burst, blood flows into the hollow organ.

The intensity of bleeding depends on the diameter of the damaged artery or vein, blood pressure, comorbidity and the state of the patient's coagulation system. There are many reasons leading to such complications. This may include:

• heavy physical activity;
• errors in the diet;
• emotional stress;
• various associated pathologies of the gastrointestinal tract.

Most often, bleeding occurs capillary type. They are characterized by the taste of blood in the mouth, weakness, nausea, but pass without medical intervention. However, despite its apparent harmlessness, frequent outpourings of liquid blood from the dilated veins of the esophagus can lead to the development of anemia, changes in the patient's electrolyte balance and disruption of the coagulation system.

Severe bleeding without appropriate treatment is the most common cause of death in patients with varicose veins of the esophagus and stomach. If the patient has vomiting with streaks of blood, this is a mandatory reason for contacting a doctor. In this case, the color of the discharge is important: scarlet blood indicates a rupture of the vessel in the upper part of the esophagus, and dark discharge the colors of “coffee grounds” indicate the duration and massiveness of gastric bleeding.

How to make the correct diagnosis

Since esophageal varicose veins are most often the result of other diseases, the diagnosis is based on a thorough history of the patient's life. If this is a man in his 50s, leading a busy lifestyle, abusing alcohol, then the initial picture is already clear. Liver diseases, and especially transferred viral hepatitis C are considered aggravating circumstances.

An important support for differential diagnosis can also be laboratory research methods. Biochemical analysis blood, control of the coagulation system, lipids and blood protein will confirm the preliminary conclusions of specialists. Considering that with varicose veins of the gastrointestinal tract there is a high probability of bleeding, it is mandatory to determine the blood type, Rh factor and the time of formation of a blood clot.

For a more accurate diagnosis modern medicine offers a lot of methods of instrumental examination of the state of the esophagus and stomach. X-ray of the esophagus and stomach, as well as ultrasound of problematic organs, has proven itself well with a similar pathology. With their help, you can quite clearly determine the site and degree of damage to the arteries and veins that supply these organs with blood.

The widely used method of fibroesophagoscopy gives the most complete characterization of the affected areas, however, this method requires some caution during manipulation. The introduction of a special probe into the esophagus and stomach can damage the compromised mucosa and lead to massive bleeding.

It is also not recommended to use gastroscopy at the height of bleeding, as this procedure can damage the formed blood clot. However, the use of a fibrogastroscope remains at the discretion of the attending surgeon and endoscopist.

Types of treatment for varicose veins of the esophagus and stomach

As already noted, varicose veins in the gastrointestinal tract is a consequence of the patient having various pathologies of the liver and cardiovascular system, therefore, in a calm period, all therapy is aimed at treating the underlying disease.

The main and most formidable manifestation of this disease of the vessels of the esophagus and stomach are bleeding. If the patient is diagnosed with esophageal varicose veins, treatment is primarily aimed at preventing bleeding and combating their consequences.

In medical practice, there are three main directions for solving this problem.

Traditional drug therapy

Such treatment is used during a period of relative calm and with minor bleeding in the esophagus and stomach. Its basis is the use of drugs that relieve inflammation, reduce the level of acidity in the stomach, and maintain vitamin and electrolyte balance in the patient's body.

If bleeding occurs, transfusion of blood plasma, erythrocyte mass, vasoconstrictor drugs is possible. All actions of doctors during this period should be aimed at stopping bleeding and fighting anemia.

Among the well-known drugs good feedback received the use of beta-blockers, antacids and antispasmodics. Even regular nitroglycerin has proven effective in treating esophageal varices.

Surgical treatment methods

Since in medicine varicose veins refers to surgical pathology, the main methods of treatment are developed by specialists of this profile. Modern surgery offers its patients:

• Excision of the veins of the esophagus affected by the process of varicose veins, followed by the formation of bypass collaterals.
• The imposition of a bypass anastomosis between the splenic vein and the system of the left kidney.
• Shunting of the portal vein with a special device - a stent. This technique allows you to reduce pressure in the region of this vein and unload the vessels of the stomach and esophagus.
• Recently, many clinics use the method of sclerosis or the introduction of a special adhesive solution into the veins of the esophagus, similar to the treatment of varicose veins of the lower extremities. In terms of complexity, this is the most sparing operation, giving positive result when carried out regularly. Recommended 4 - 6 injections during the year.

It is impossible not to mention the widespread use of endoscopic interventions. These techniques are indicated primarily for patients for whom a full-fledged operation is contraindicated.

Methods of surgical interventions in this case, experts use different. This includes operations from the simplest cauterization of a bleeding vessel to ligation of large areas of damaged veins. Good results are also obtained by the use of special glue, which is used to treat the provoked areas of the veins of the esophagus and stomach.

It should be noted that with the development of medical technology, most surgeons prefer minimally invasive interventions.

Is it possible to avoid complications

Changing the venous walls in the esophagus and stomach in various diseases is not a sentence for the patient. If the process has not entered a critical phase, fatal health problems can be avoided.

When a patient is diagnosed with such a diagnosis, doctors always give their recommendations on lifestyle. First of all, this category of patients should avoid physical activity. Even a short-term rise in blood pressure can provoke bleeding from thinned vessels.

A special diet has been developed for varicose veins of the esophagus. All meals that can lead to physical or chemical effects on the walls of the esophagus or stomach are prohibited. All food should be at room temperature, portions cannot exceed 200-300 grams, and the frequency of meals can reach 8 times a day.

You can't eat at night. This is also harmful for healthy person, and in the presence of varicose veins, excessive filling of the stomach before bedtime can provoke bleeding.

Varicose veins require the patient to comply with all the recommendations of the attending physician, a sparing lifestyle and an appropriate diet. When you follow these simple rules, you can avoid a formidable complication of this disease - bleeding, which threatens the patient's life.

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