Varicose veins of the stomach treatment. Varicose veins in the tissues of the stomach

Phlebectasia or varicose veins gastric veins is a disease of a dangerous category, which is manifested by an increase in the volume of 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?

Dilation of the veins of the mucous tissues of the stomach is not as common as varicose veins in the legs. The difference between pathologies lies in the causes of their occurrence and progression. Often, increased pressure of the portal vein is the result of cirrhosis of the liver, although sometimes it is the result of genetic pathologies or compression of the portal vein by a tumor of a large volume.

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

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.
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.
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.
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

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.

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Symptoms of the disease and diagnosis

On the early stages phlebectasia is asymptomatic, this 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 abdominal cavity.
In the anterior lobe of the abdominal wall, the outline of the "head of a jellyfish" is likely - 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);
the fall blood pressure blood;
increased heart rate rhythms with failures;
stomach ache;
shock state.

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 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 In most cases, the only cure is liver transplantation.

Medical treatment is carried out using the following means:

Vasopressin - normalizes the state of constricted veins.
Nitrates included in Nitroglycerin due to a decrease in pressure in the portal vein.
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.

The manifestation of attention to your health consists in observing simple principles. Such recommendations will actually help in maintaining the work of the digestive tract on required level and prevent exacerbations.

Causes and treatment of varicose veins in the stomach

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:

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.
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.
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.
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 medicines 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 those indicated medications Colloidal solutions, multivitamin complexes, antacids and astringents are widely used.

Surgical direction - It is carried out using three main methods:

Ligation of problematic veins - during the manipulation, a specialized rubber bandage is used. The technique is considered highly effective.
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.
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 spoon is brewed in a glass of boiling water Japanese Sophora, consumed four times a day, the total course of treatment should not exceed two months;
rose hips and red ashberries 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 of the stomach - causes and methods of treatment

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

Causes

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

In addition, the reasons for the development of VRV (varicose veins) of the esophagus and stomach can be:

Among the factors provoking the disease include:

cardiovascular insufficiency;
oncological pathologies;
hereditary predisposition.

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

Symptoms and signs of the disease

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

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

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

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

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

How the disease is diagnosed

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

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

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

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

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

Treatment Methods

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

Medicines

Conservative treatment can be effective only in the early stages of pathology or as a supportive technique in rehabilitation period after surgery. Application medicines allows you to stabilize the patient's condition, slow down and stop the development of varicose veins, avoid pathological consequences.

Varicose veins of the stomach are treated with the following medications:

Vasopressin - causes contraction of the arterioles of the internal organs, which leads to a decrease in portal blood flow and a decrease in pressure in the portal vein. It is administered intravenously. With a fairly high efficiency (up to 55%) of the drug, its use causes a number of serious side effects in 20-30% of cases: ischemia, impaired heart rate, hypertension;
Nitrates - are used to reduce the side effects of Vasopressin in relation to peripheral vessels. Their action has a dilating effect on the portal-systemic collaterals (connections), resulting in a decrease in pressure in the portal vein. Applied in the form of a patch and reception under the tongue;
Somatostatin - reduces portal blood flow and portal pressure by increasing resistance in the arteries of the internal organs. The effectiveness is not inferior to Vasopressin, but the risk of developing side effects almost doubled. Its use is possible for a long period, while nausea, abdominal pain, impaired glucose tolerance can be observed.

Astringents, colloidal solutions, vitamins, antacids may be prescribed.

Self-treatment of pathology is unacceptable - only the correct diagnosis and medical recommendations can slow down the progression of the disease.

Surgical intervention

The development of the disease and the increase in symptoms may serve as a basis for surgical intervention - only in this case, the chances of preventing bleeding are greatly increased.

The following types of surgical treatment are used:

Sclerotherapy: the introduction of a sclerosant drug into the affected veins, causing them to stick together and redirect venous blood flow in a different direction. The method is used not only to prevent, but also to stop bleeding with a positive result of 90%. The method requires repetition, the multiplicity of which is determined individually;
Ligation of dilated veins: performed using a special rubber bandage and is a more effective technique;
Shunting in intrahepatic tissues: a stent (a special design for expansion) is inserted into the liver, connecting the portal and hepatic veins;
Anastomosis: creating a message between the portal system and the vena cava system;
Sheathing of the affected arteries and vessels;
Devascularization: complete removal of the affected veins with their replacement with a prosthesis.

To surgical methods resort to ineffectiveness conservative treatment and a growing risk of bleeding. The choice of method depends on the severity of the patient's condition.

Folk remedies

Varicose veins of the stomach, like other forms of pathology, cannot be completely cured, however, the use of a complex of drugs can effectively resist the development of the disease. Among these methods, the use of drugs for folk recipes can alleviate the patient's condition:

Fruits of mountain ash and wild rose. Take 1 tbsp. l. berries, pour 0.5 liters of water, bring to a boil, insist and drink during the day in portions of 100 ml;
Leaves of verbena officinalis. 2 tbsp. l. crushed leaves pour 200 ml of water, boil for 10 minutes, insist and take 1 tbsp. l. three times a day;
Decoction of hazel bark. The crushed raw materials (15 g) are poured into 500 ml of water, boiled for 10 minutes, insisted and taken shortly before meals, 100 ml 4 times a day.

Self-medication in the diagnosis of pathology is unacceptable, the risk of severe complications is too high. Even folk remedies should only be taken under the supervision and consent of a physician.

Prevention

The complex of effective measures for varicose veins also includes preventive measures - after all, the patient must necessarily prevent the progression of the disease. To this end, it is recommended:

Rational nutrition is of great importance for the prevention of any disease. With varicose veins of the stomach, the following principles should be followed:

Eat fractionally - 6 times a day in small portions;
The last meal - no later than 3 hours before bedtime;
Saturate the diet with vegetables and fruits (citrus fruits, currants, Bell pepper, cherries with cherries, potatoes), vegetable oils, nuts, herbs, legumes;
Eliminate alcohol, coffee and strong tea, flour products, sweets, hot spices, spices, carcinogens;
Prepare foods with gentle processing methods: boiling, baking, stewing.

Juice fast: drinking juices or fresh fruits (vegetables) for 7-8 days. Preparation and exit from fasting are carried out only on the recommendation of a nutritionist and phlebologist;
"Colorful" diet: when eating vegetables and fruits different color the body is saturated with various sets of vitamins and minerals. Blue - eggplant; yellow - bananas, apples; red - tomatoes, berries; green - cucumbers, peas; orange - citrus fruits, pumpkin.

Possible complications and consequences

Varicose veins in the stomach do not occur suddenly. Advanced forms of the disease are fraught with serious consequences for the body up to death. In list possible complications can be:

tachycardia;
ascites (abdominal dropsy);
increase in pressure.

If there are signs of discomfort in the esophagus and sternum, the frequent presence of heartburn, you should undergo an examination to find out their causes. And in the case of diagnosing varicose veins in the stomach, make every effort to prevent the progression of the disease, while not forgetting about prevention and proper nutrition.

Cardiologist

Higher education:

Cardiologist

Kabardino-Balkarian State University named after A.I. HM. Berbekova, Faculty of Medicine (KBGU)

Level of education - Specialist

Additional education:

"Cardiology"

State Educational Institution "Institute for the Improvement of Doctors" of the Ministry of Health and Social Development of Chuvashia

When you hear the word "varicose veins", swollen tortuous veins on the legs usually appear. So it is - the pathology most often affects the lower limbs, and it is here that it is visible to the naked eye. But functional impairment vessels can occur anywhere. Varicose veins in the tissues of the stomach are also accompanied by structural changes - the vessels expand, lengthen, form knots and loops. Pathology develops against the background of hepatic lesions and is accompanied by minor or profuse hemorrhages.

Features of the defeat of the stomach

Varicose expansion of the blood vessels of the stomach is an extremely dangerous pathology. She may be:

congenital - vascular damage is diagnosed from the moment of birth. It is associated with genetic disorders, it can develop against the background of a complicated pregnancy;
acquired - the transformation of blood vessels causes high blood pressure in the portal vein. It is responsible for the blood supply to the liver. Violation of the hepatic blood flow makes the vessels fragile - at any moment they can burst.

Congenital varicose veins of the stomach are extremely rare. Usually, specialists diagnose an acquired form of pathology. And patients are more susceptible to it old age. At the initial stages of development, varicose veins of the stomach are absolutely asymptomatic, and therefore it is rarely possible to diagnose the disease in a timely manner. There are several classifications of gastric varicose veins, but each of them is based on structural changes in blood vessels. According to the endoscopic classification, pathology is divided into three degrees:

1 - veins less than 5 mm in diameter, almost indistinguishable on the gastric mucosa;
2 - the diameter of the veins is increased to 10 mm, their single bulges are observed;
3 - veins with a diameter of more than 10 mm have multiple bulges, form nodes.

Reasons for the development of pathology

Varicose veins in the stomach cause an increase in blood pressure in the portal vein. And it, in turn, is provoked by the development of cirrhosis of the liver. Sometimes portal hypertension occurs due to congenital anomalies or compression of the vessel by a tumor, thrombosis, or cholelithiasis stone.

Increased pressure contributes to the redistribution of blood and its increased circulation through the lateral (collateral) vessels of the upper region of the stomach. Pathology develops gradually, squeezing the vessel by the tumor cannot cause sudden changes. It usually occurs precisely because of chronic cirrhosis of the liver. Its development is facilitated by:

alcohol abuse;
drug use;
uncontrolled intake of drugs;
hepatitis B and C;
prolonged cholestatic syndrome (decrease in the amount of bile entering the duodenum).

Sometimes cirrhosis occurs for other reasons, and varicose veins develop as a complication of liver damage. Other causes of varicose veins include:

functional disorders of the stomach and pancreas;
echinococcosis (helminthic disease);
tuberculosis;
polycystic (formation of cystic cavities);
fibrosis (proliferation of connective tissue);
sarcoidosis (formation of granulomas);
adhesions and cysts of various etiologies;
aneurysms of the vessels of the liver, spleen;
eosinophilic gastroenteritis (infiltration of the gastric mucosa with eosinophils);
intestinal obstruction;
general insufficiency of blood vessels and heart.

Sometimes the development of varicose veins of the stomach provokes a sharp load: fever, weight lifting.

Symptoms of the disease

Symptoms of pathology are individual, its clinical picture depends on many factors. Often at first the disease is asymptomatic, sometimes rapidly. But in any case, gastric varicose veins are accompanied by:

heartburn;
belching;
difficulty in swallowing food;
chest discomfort;
frequent heartbeat;
blood impurities in the stool.

May be observed pain, weakness. The urge to vomit is not eliminated by changing the diet, eating foods that normalize digestion. The vomit contains mucus, in which blood clots are sometimes observed.

Diagnosis of vascular lesions

If varicose veins of the abdominal cavity are suspected, the patient is prescribed a medical examination. Diagnosis usually includes:

clinical and biochemical analysis of blood (concentration of platelets, leukocytes, cholesterol, liver enzymes, bilirubin);
fibroesophagoscopy (assessment of the condition of the veins, mucosa, identification of the causes of bleeding and signs of pathologies with similar symptoms);
contrast radiography (detection of damaged vessels);
duplex scanning of blood vessels (study of the anatomy of blood vessels and the degree of their stretching).

It is possible to identify vascular changes and their causes by analyzing the symptoms and data confirming the progression of liver cirrhosis.

Pathology therapy

With varicose veins of the stomach, it is important to prevent bleeding. If it does occur, everything possible must be done to stop the hemorrhage. Based on this, there are three main approaches to the treatment of pathology:

therapeutic;
endoscopic;
operational.

The first two are applicable in the early stages of the development of pathology or after effective relief of hemorrhage. Later stages are subject to surgical treatment, since the probability of death caused by hypovolemic shock is high.

To control portal hypertension, cardiovascular drugs are used, in particular, beta-blockers that lower blood pressure, and nitroglycerin (effective only with prolonged use). Carrying out hemostatic therapy, the doctor chooses the best way:

medicinal effect;
transfusion of blood or plasma;
introduction of colloidal solutions.

Damaged veins are removed by electric current (electrocoagulation). Bandages (rubber discs) or special probes are used to stop bleeding, squeezing damaged areas of blood vessels. In parallel, carry out therapy aimed at enhancing blood coagulation. There are other methods of therapy for gastric varicose veins:

sclerosing - the introduction of a special solution into a vein;
portosystemic intrahepatic stent shunting - implantation of a porto-caval anastomosis;
anastomosis - a decrease in the volume of the stomach;
sheathing of veins;
vein removal.

The decision to use a certain method is made on the basis of the anamnesis, research results and the patient's well-being. Sometimes the only cure is a liver transplant.

Disease prevention

The main preventive measure for gastric varicose veins is the organization proper nutrition. To do this, you must follow some rules:

Eat at least four times a day - little by little, at regular intervals;
Do not eat at night;
Be sure to have breakfast;
Avoid using:

- alcoholic beverages;
- fried, sour, smoked, pickled, spicy foods;
- confectionery;
- strong tea, coffee, carbonated drinks;
- too cold and hot food.

You need to give preference to:

cereals;
vegetables;
poultry meat;
lean fish.

Products should contain rutin and vitamins that prevent vein fragility and promote normal blood circulation. It is important to periodically diagnostic examination and lead an active lifestyle, dosing physical activity.

High mortality in gastric varicose veins is due to the serious course of comorbidities and the severity of complications. Help with hemorrhages in such circumstances is often symptomatic, and the treatment of portal hypertension is not always successful. Therefore, increased attention should be paid to the prevention of pathologies that contribute to the development of varicose veins.

Varicose veins are currently a widespread pathology and one of the main causes of early onset of disability. Although most patients experience the development 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.

The main causes of varicose veins of the esophagus

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 lower third esophagus and cardia 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 seeming 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 may become laboratory methods research. 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.

Varicose veins of the esophagus (diagnosis by fibroesophagoscopy)

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 presence in the patient of various pathologies of the liver and of cardio-vascular 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, it is possible to transfuse blood plasma, erythrocyte mass, vasoconstrictor drugs. 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 at regular. 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 follow all the recommendations of the attending physician, a sparing lifestyle and an appropriate diet. When these simple rules are followed, one can avoid a formidable complication of this disease - bleeding, which threatens the patient's life.

Symptoms of varicose veins

The first stage of the disease does not manifest itself in the body, so it is difficult to determine the ongoing changes. With the development of pathology, the following symptoms may appear:

heaviness, dull chest pain;
an increase in the abdomen due to the large volume of accumulated fluid;
appearance on abdominal wall noticeable dilated veins;
shortness of breath with minimal physical exertion;
heartburn, not depending on the products used;
difficulty swallowing food.

It is important to notice the presence of signs and consult a doctor in time. During treatment, urgent measures are needed in order to have time to eliminate possible damage to the body.

Attention: It is not often possible to determine the presence of varicose veins in time. The disease manifests itself mainly when the veins rupture. Bleeding makes all the signs of the disease more noticeable.

With bleeding, accompanying symptoms are possible:

vomiting with drops of blood;
blood in the stool and staining it black;
lowering blood pressure and increased heart rate;

Bleeding is often profuse, although there are exceptions. Treatment if any of the signs are detected should be started on time. Untimely assistance leads to a strong deterioration in the condition, a fatal outcome is possible.

Causes of varicose veins of the stomach

Home stomach - . The veins expand due to the increased pressure, the outflow of blood passes with disturbances. The condition may occur due to a blood clot, squeezing a vein. The following diseases of the pancreas or liver can affect:

cirrhosis or chronic hepatitis.
Sarcoidosis.
Malignant or benign tumor.
Aneurysms of the arteries of the spleen or liver.
Fibrosis.

The disease can be inherited, it can manifest itself at any time. With cirrhosis of the liver, the structure of the organ changes, the tissues grow and contribute to the cessation of its work. Varicose veins occur serious complication first illness.

How the disease is diagnosed

Diagnosis of the disease is possible with instrumental examination. The following methods are used:

a blood test performed to examine the general condition of the body;
liver tests to detect coagulopathy;
x-ray with contrast to examine the state of the digestive system;
Ultrasound of the abdominal organs.

When detected, immediate measures are taken to prevent the development of the problem.

Additional Information: The classification of the disease involves dividing it into 3 stages. The first is a slight expansion of the veins, the last is bleeding in the stomach cavity.

Treatment

Pathology is most often detected at a late stage, which often leads to hypovolemic shock or death. The patient is entitled to immediate hospitalization, resuscitation. The first step is to stop the bleeding, stabilize the state of the body, replenishing the bcc.

Medical treatment

Treatment of varicose veins involves squeezing the problem area. This way you get rid of the bleeding. The effectiveness of treatment is 90%. When operating on damaged vessels of the esophagus, relapses are possible. Often another surgery is performed. To increase the chances of recovery, the following methods are used:

Introduction into a vein that has burst, a special solution to reduce the outflow of blood.
Monthly repetition of actions aimed at stopping possible internal bleeding.
The use of drugs that affect gastric juice, to reduce pressure on the walls of blood vessels.
Astringents that stop possible bleeding.
Multivitamin complexes to increase the elasticity of blood vessels.

Surgical intervention

Activities are carried out in several ways: damaged veins are tied using a rubber bandage, intrahepatic material is shunted to reduce pressure. A special device is inserted into the liver to avoid the accumulation of blood in the cavities, preventing bleeding from opening. Actions are carried out using an X-ray machine to avoid possible errors.

The third method is splenorenal shunting. Used to prevent fluid accumulation. A shunt connects certain veins, preventing hemorrhage.

Folk remedies

To complement the treatment with basic means, you can use traditional medicine. Activities improve bowel function, improve the choleretic process. For treatment, the following means are used:

Sophora japonica tincture. 1 st. l. drink is diluted in 1 glass of boiled water. Drink the composition 4 times a day before meals.
Rose hips or rowan berries: 1 tbsp. l., mixed with 0.5 l. water. The liquid with fruits is kept on fire for 5 minutes, then it cools down and is drunk. Use daily for 0.5 liters. composition, in parts, at regular intervals.
drops from chestnut flowers(sold in a pharmacy). 30 drops of the solution are added to a glass of warm water. Drink a glass a day.
Propolis tincture. It is mixed and used similarly to the previous composition.
Liquid formulations of calendula, chamomile: mix them by adding 10 drops of each product to a glass of water. Use the solution in a warm form 4 times a day for at least a month.

Don't forget that folk way treatment does not help to get rid of a dangerous disease, but only serves as an addition to the main treatment.

Diet

With varicose veins, you must follow the basic rules of nutrition. You need to eat at least 4 times a day. Stress on digestive system significantly reduced, as the amount of food received at a time decreases. It is forbidden to remain without food for a long time, even to be a little hungry. It is worth eating at the same time so that the gastric mucosa gets used to a constant routine. Skipping meals on a set schedule is not recommended.

Food should be thoroughly chewed - you should not rush when eating it. To develop such a habit, it is worth removing all distractions: TV, book, Internet. Avoid eating before bed. The last time to eat about 2 hours before a meal, no later.

The diet does not imply clear rules, experts usually prescribe general recommendations on nutrition. With varicose veins of the stomach, you should not eat the following products:

fatty foods, fried foods, fast food and the like;
meat, poultry, fish are not prohibited for consumption, but are not recommended in large quantities;
smoked foods, pickles that can retain water in the body;
foods high in fiber;
fresh vegetables and fruits - they must be subjected to heat treatment;
alcoholic or carbonated, as well as caffeinated drinks;
substances that affect the cardiovascular system to any extent.

Important: The disease is dangerous because of the possibility of heavy bleeding into the stomach cavity. It is necessary to exclude any products that can exert a strong burden on the body. Do not use substances that will irritate the digestive system.

Risks and forecasts

Often deaths in varicose veins of the stomach occur due to untimely access to doctors. Complex pathologies that occur during the development of the disease quickly lead to a deterioration in the condition. Vascular problems, complicated by heavy bleeding, liver cirrhosis, are eliminated only at the initial stage of development.

Mortality in the presence of the disease is 50%. In about 79% of cases, internal bleeding can be stopped on time. The return of the disease with successful treatment is possible in 55% of cases. Given the statistics, do not forget about the right diet. The measures taken will delay or prevent the onset of the disease.

Varicose veins of the stomach are considered extremely dangerous disease that can arise even from simple overeating. Everyone should carefully monitor the diet, the amount of food consumed and the quality of the purchased products so that the consequences of the disease do not turn out to be an unpleasant surprise.

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 ( high blood 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 this indicator up 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:

Ascites (accumulation of fluid in the abdominal cavity, in which the stomach increases in size).
Painless vomiting of blood, usually profuse.
Tachycardia (strong heartbeat).
Hypotension (low blood pressure).
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:

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.
Ligation of varicose veins using a rubber bandage. The method is superior in efficiency to sclerotherapy.
Intrahepatic shunting. Reducing pressure by inserting a stent under x-ray guidance into the mid-liver area to connect the hepatic and portal veins.
Splenorenal shunting. It is produced to prevent bleeding by combining the splenic vein and the vein of the left kidney with a shunt.
Drug treatment - the use of vasoconstrictor drugs (Vasopressin), nitrates to reduce pressure in the portal vein (Nitroglycerin), as well as Somatostatin (or its analogue Octreotide) to reduce blood pressure internal organs and narrowing of 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.

It is required to avoid increased physical exertion, gravity must be rolled over, 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.