Advertising on the portal

Varicose veins of the stomach and lower esophagus, treatment, symptoms, causes, signs. Varicose veins of the stomach - causes and methods of treatment

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

What are gastric 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 development of the disease do not have symptomatic manifestations, which increases its danger. There are certain causes 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 lumens blood vessels single. Patients do not complain about the deterioration of their condition; the problem is diagnosed using endoscopy.
  2. Characterized by tortuosity and unevenness of veins. General indicators increases do not exceed 3 mm, narrowing occurs for short periods of time. In cases of exception, spontaneous bleeding may occur.
  3. It is characterized by a noticeable decrease in vascular lumens and their swelling. When diagnosing, nodes and decreased wall tone are detected. Symptomatic manifestations are present, the likelihood of bleeding increases.
  4. It is determined by significant depletion of the mucous membranes of the stomach, 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 compression gradually leads to the appearance of characteristic changes.

Secondary division informs about the factors of its formation:

  • acquired option – occurs when increased rates pressure in the portal vessel responsible for supplying 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 - pathological process is detected from the moment of birth, can be formed as genetic predisposition or complicated pregnancy;
  • congenital - refers to rare formations.

In most cases, an acquired version of varicose veins of the gastric venous vessels is diagnosed.

Causes

The main source of occurrence pathological condition is a portal form hypertension, causing enlargement of the veins in the digestive organ. Sometimes the problem occurs against the background of liver cirrhosis - as a consequence of multiple scars. Less common causes of the disease include:

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

If there is a history of hepatitis and cirrhosis of the liver, it is necessary to visit more often preventive examinations gastroenterologist - to capture the disease on initial stages occurrence. Stomach under negative influence of these factors becomes vulnerable and easily susceptible to disease.

Who's at risk

Average statistical data indicate that the majority of patients belong to certain subgroups:

  • gender – males are more likely to suffer from gastric varicose veins;
  • age period – the problem is diagnosed after the 50th birthday;
  • concomitant diseases - in the presence of diseases of the liver, pancreas, heart muscle and liver.

Patients with cirrhosis are especially distinguished - according to clinical research, only one person out of ten does not get sick.

Clinical picture of gastric varicose veins

The initial stages of phlebectasia do not have obvious symptomatic manifestations, which causes difficulties in correctly determining the diagnosis. The gradual progression of the disease gives rise to obvious clinical signs:

  • feeling of discomfort and heaviness in the thoracic area;
  • increase in volumes abdominal cavity– due to the liquid accumulating in it;
  • dilated venous vessels lead to the formation of a jellyfish head, a symptom characterized by the creation of a pattern of enlarged veins;
  • problems with breathing freely after physical or physical activity;
  • spontaneous heartburn, independent of food intake;
  • problems with swallowing.

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

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

Violation of the integrity of blood vessels can cause both minor and massive hemorrhage. The patient requires emergency surgical care– in case of inaction, the disease will become fatal.

Diagnostic measures


When visiting the clinic, the patient is referred for a consultation with a gastroenterologist. The doctor collects anamnesis: time of occurrence negative manifestations, personal feelings of the patient, existing diseases. Visual inspection with palpation examination allows making a preliminary diagnosis.

To confirm, the patient is sent for separate laboratory and instrumental examinations:

  • all options for blood testing - to identify hidden inflammatory processes and other deviations;
  • study of blood clotting indicators;
  • Ultrasound - a technique that allows you to identify altered blood vessels;
  • fibroesophagoscopy - with the help of a device, the stomach, the condition of the mucous membranes are thoroughly examined, and places of violation of the integrity of blood vessels are identified.

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

Modern methods of treatment

Varicose veins of the gastric veins are not classified as independent diseases and does 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, which are recommended by the attending physician.

If there are prerequisites for its elimination, it may be prescribed conservative therapy or surgery. 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 blood pressure levels;
  • nitrates - to improve the functionality of the portal vein, lower pressure.

In addition to those indicated medications Colloidal solutions, multivitamin complexes, antacids and astringents are widely used.

Surgical direction - carried out using three main methods:

  1. Ligation of problem veins - during manipulation, a specialized rubber bandage is used. The technique is considered highly effective.
  2. Intrahepatic bypass surgery is prescribed to reduce blood pressure. The main goal of the technique is to create a connection between the portal and hepatic vessels.
  3. Splenorenal shunting involves joining the veins of the left kidney and spleen using a shunt. It is produced for prophylactic purposes - to prevent spontaneous bleeding.

Nutritional - included in the mandatory comprehensive program treatment of varicose veins of the gastric vessels. Diet requirements are as follows:

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

Dishes are served warm. Allows cooking by boiling, stewing, baking or steaming.

Folk remedies

Home recipes are not particularly effective for varicose veins; most cases require surgical intervention. Usage folk methods is agreed with the attending physician. To frequently used medications traditional healers include:

  • Brew a large spoon in a glass of boiling water Japanese Sophora, consumed four times a day, the total course of treatment should not exceed two months;
  • rosehip and red rowan fruits are taken in equal volumes– take a large spoon, add half a liter of liquid, boil for five minutes, cool and drink half a glass throughout the day.

Possible complications of pathology

Problematic complications of varicose blood vessels of the stomach include spontaneous bleeding. They can arise from any reason - thinned mucous membranes cannot create a full-fledged barrier.

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

Prevention measures

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

  • monitor liver health;
  • follow all instructions of specialists;
  • stabilize blood pressure levels;
  • avoid excessive indulgence in alcohol, nicotine and drugs;
  • switch to a healthy diet;
  • carry out vitamin therapy;
  • reduce the amount of lifting of 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 mortality rate - due to complications and concomitant diseases. Progressive cirrhosis can cause complicated bleeding.

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

Damage to 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 determining factor in determining the likely prognosis.

Garbuzenko D.V. Therapeutic tactics for bleeding from gastric varices // Annals of Surgical Hepatology - 2007. - T. 12, No. 1. - P. 96-103.
When citing an article, a link to the author is required!


Even though varicose veins Gastric veins are a relatively rare pathology and occur in approximately 20% of patients with portal hypertension; the high mortality rate for bleeding from them, as well as the lack of a uniform standard of treatment and prophylactic measures, makes the problem extremely urgent.

CLASSIFICATION OF GASTRIC VARICOSE VEINS

The most widespread classification of gastric varicose veins is based on their localization and connection with esophageal varicose veins. In addition, gastric varicose veins can be primary or secondary. IN the latter case they develop, as a rule, after endoscopic treatment.
Varicose veins that pass from the esophagus to the stomach are defined as gastroesophageal and are of two types:
1) gastroesophageal varicosities of the first type continue from varicose veins of the esophagus along the lesser curvature of the stomach 2-5 cm below the cardia;
2) gastroesophageal varices of the second type pass from the esophagus towards the fundus of the stomach.
Isolated gastric varices form in the absence of esophageal varices. Among them are:
1) isolated type 1 gastric varicose veins, which are located in the fundus of the stomach;
2) isolated varicose veins of the stomach of the second type, representing ectopic phlebectasias of the pylorus, antrum and body of the stomach. They are usually secondary.
The Japanese Society for the Study of Portal Hypertension classifies gastric varices by color (white and blue), shape (straight, nodular and tortuous), presence of red color signs (RC0-3), localization (cardiac, fundal and varicosities occupying both sections) .

FORMATION MECHANISM
VARICOSE VEINS OF THE STOMACH

Gastroesophageal varicose veins, predominantly of the first type, are in most cases observed in patients with extrahepatic portal hypertension caused by impaired patency of the portal vein, less often in liver cirrhosis. The cause of isolated type 1 gastric varicose veins is often segmental (left-sided) portal hypertension, which develops as a result of thrombosis or narrowing of the splenic vein, usually against the background of pancreatic pathology.
Gastroesophageal varices of the first type, like varicose veins of the esophagus, drain predominantly through the left gastric and coronary veins. The term “coronary vein” refers to the anastomoses between the left and right gastric veins. The left gastric vein ascends along the lesser curvature of the stomach to the left into the lesser omentum to the esophageal opening of the diaphragm, where it communicates with the veins of the esophagus, and then, bending back down and to the right behind the omental bursa, flows into the portal vein or, when the blood flow changes its direction, into the azygos system veins. Isolated gastric varices are formed as a result of reversal of blood flow through the splenic, gastroepiploic and posterior gastric veins. In this case, the term “posterior gastric vein” refers to anastomoses between the left and short veins of the stomach. Isolated type 2 gastric varices are often combined with dilatation of the branches of the gastroepiploic veins. Gastric varices are usually drained through spontaneous gastrorenal shunts, which are formed between the veins of the gastrosplenic vascular territory and the left renal vein, through the inferior phrenic or adrenal veins. A case of gastropericardial shunt formation with the participation of the posterior gastric vein is described.
Endoscopic treatment of esophageal varices often contributes to the development of secondary, predominantly isolated gastric varices. On the other hand, sclerotherapy of varicose veins of the esophagus, with the caudal direction of the drug flow, can achieve persistent eradication of gastroesophageal varicose veins, especially the first type.

DIAGNOSIS OF GASTRIC VARICOSE VEINS
AND RISK FACTORS FOR BLEEDING FROM THEM

Gastric varices are most often diagnosed during screening of patients with portal hypertension, being examined for the presence of varices, or in the case of gastric bleeding. However, standard endoscopic examination does not always allow an accurate assessment of the true prevalence of this pathology due to the deep location of dilated veins in the submucosa of the stomach and it can be difficult to distinguish them from folds. The quality of diagnosis can be improved through computed tomography and endoscopic ultrasonography.
However, information about the size and localization of gastric varicose veins, the presence of inflammatory changes in the gastric mucosa, obtained during endoscopic examination, is essential for hazard assessment hemorrhagic complications. In this case, risk factors for bleeding are large-nodular varicose veins blue color, its fundic localization, red spots on the gastric mucosa in combination with pronounced violation liver functions.
It is believed that the leading mechanism contributing to the rupture of varicose veins is a combination of increased intraluminal pressure and weakness of the vessel wall. According to Laplace's law, the stress of the vascular wall (T) is proportional to the value of intravascular pressure (P), the diameter of the vessel (D) and inversely proportional to the thickness of its wall (W):

T=P*D/W

Although fundic varicosities are located in the submucosa, when large sizes they penetrate the muscular lamina of the gastric mucosa, pass through the lamina propria and protrude into the lumen of the stomach, becoming vulnerable to damage. In this case, the risk of their rupture increases sharply.
Due to the formation of spontaneous gastrorenal shunts, the indicators of the portohepatic pressure gradient in patients with gastric varices are lower than those with esophageal varices, which is why most bleeding develops at values ​​less than 12 mmHg.

TREATMENT AND PREVENTIVE MEASURES
FOR BLEEDING
FROM VARICOSE VEINS OF THE STOMACH

Obturator probes play an important role in the complex of conservative measures to stop bleeding from gastric varices. For rupture of fundal and ectopic varicose veins, a Linton-Nachlas probe is used. In this case, hemostasis is achieved by inflating a single gastric balloon to 600 cm3. The Sengstaken-Blakemore triple-lumen probe is used in cases of rupture of esophageal varices or gastroesophageal varices. However, their effect is short-term and permanent hemostasis is observed in less than 50% of cases.

Pharmacotherapy

In contrast to esophageal varices, there is little data on the use of vasoactive drugs (analogues of vasopressin, somatostatin, nitroglycerin) for acute bleeding from gastric varices. However, given the similarity of formation and clinical course, it can be assumed that such treatment can be effective for gastroesophageal varicose veins of the first type. Antibiotic therapy should be carried out as early as possible, because It has been shown that the addition of a bacterial infection, especially in patients with liver cirrhosis, increases the incidence of complications and mortality, and with the use of cephalosporins, the short-term prognosis is significantly improved.
The role of non-selective β-blockers and nitrates in the primary prevention of bleeding from gastric varices and their relapses has not been fully established and requires further evaluation.

Endoscopic treatment

Standard endoscopic sclerotherapy for varicose veins of the esophagus and gastroesophageal varicose veins of the first type consists of injection of drugs that cause endothelial damage, thrombosis and subsequent sclerosis of varicose nodes, either directly into the dilated veins (5% ethanolamine oleate solution, 5% morruate solution sodium, 1.5-3% solution of sodium tetradecyl sulfate), and paravasally (1% solution of polidocanol (ethoxysclerol)). In order to obliterate gastric varicose veins, histoacryl (N-butyl-2-cyanoacrylate) is usually used. Administration of the drug in small doses through intravaricose injections leads to an instant polymerization reaction. When mixed with blood, it transforms from its natural liquid state into a solid state and blocks the lumen of the vein. This allows, in most cases, to quickly stop active bleeding from gastric varices. Despite the fact that the relapse rate reaches 40%, this method is more effective than standard endoscopic sclerotherapy and is currently considered not only as a “first-line” treatment for bleeding from fundic gastric varices, but also as a method of secondary prevention.
The most common and usually transient side effects of varicose vein obliteration with histoacryl are fever and mild abdominal pain. Severe complications are rare. These include embolism of the pulmonary artery and cerebral vessels, thrombosis of the portal and splenic veins, retroperitoneal abscess, and splenic infarction. The likelihood of developing embolism is higher in patients with large gastrorenal shunts and hepatopulmonary syndrome, which is characterized by arterial hypoxemia and intrapulmonary vascular dilatation with the presence of direct arteriovenous anastomoses, which facilitates the entry of the polymerizing substance into the systemic circulation. Therefore, in this category of patients, obliteration of varicose nodes with histoacryl should be avoided and replaced with sclerotherapy, for example, 5% ethanolamine oleate solution, combining it with vasopressin infusion, or resort to other treatment methods.
With endoscopic ligation, in contrast to the induction of chemical inflammation and thrombosis caused by the introduction of sclerosing agents, the elastic ring, capturing areas of the mucous and submucosal layer of the stomach in the area of ​​varicose veins, leads to strangulation and subsequent fibrosis. However, in some cases, deep and extensive ulcers may form in the ligation area. Considering that the fundic gastric varices are usually large and directly connected to the significantly dilated left gastric or posterior gastric veins, the volume of blood flow through them is greater than through esophageal varices. In this regard, in areas of damaged gastric mucosa, bleeding often recurs, reducing the effectiveness of endoscopic ligation, compared with obliteration of varicose nodes with histoacryl, which is the “gold standard” of treatment in this situation.

Interventional radiology methods

In 1969, J. Rosh et al. put forward the idea of ​​creating an intrahepatic fistula between the branches of the hepatic and portal veins for the treatment of portal hypertension. Currently, transjugular intrahepatic portosystemic shunt (TIPS) has received widespread clinical use. Its main advantage is that it is less invasive than with surgical methods decompression of the portal system.
There are few publications concerning the use of this method in patients with gastric varicose veins. It is indicated that in the vast majority of them, TIPS is effective both in cases of acute bleeding and when used for prophylactic purposes. Moreover, the relapse rate after achieving primary hemostasis is 15-30% within 1 year. The reason for them is long term is usually stenosis or occlusion of the shunt as a result of intimal hyperplasia of the area hepatic vein or thrombosis of the endoprosthesis due to low blood flow through it. This complication is observed in at least a third of patients and serves as an indication for re-intervention. Serious problem is post-shunt encephalopathy, which develops in 20-30% of cases and may be difficult to treat.
During the first year after the intervention, mortality varies from 10 to 50%, with the most common cause being sepsis, multi-organ systemic dysfunction, and recurrent bleeding. The prognosis is worse in patients with liver cirrhosis who are class C according to the Child-Pugh criteria. However, they are the main candidates for TIPS. Other unfavorable factors include high levels of serum bilirubin, creatinine, alanine aminotransferase, the presence of encephalopathy, and the viral nature of the disease.
The British Society of Gastroenterology recommended TIPS for patients with cirrhosis and gastric varices as a “second-line” treatment for acute bleeding, and for the prevention of recurrence in case of ineffective endoscopic measures. However, further research into the role of this method is necessary, especially when the portohepatic pressure gradient is less than 12 mmHg. and the presence of large gastrorenal shunts.
The balloon-occlusion retrograde transvenous obliteration (BRTO) method proposed by H. Kanagawa et al. in 1996 for the treatment of gastric varices, it is quite effective and safe and is a good alternative to TIPS. This intervention is technically feasible only in the presence of functioning gastrorenal shunts, which occur in almost 85% of patients with gastric varices. A sclerosing agent (usually a 5% solution of ethanolamine oleate with iopamidol) through a catheter with an inflatable balloon, passed into the femoral or internal jugular vein, and then into the left adrenal vein through a gastrorenal shunt, it is introduced into the varicose veins of the fundus of the stomach and the veins that feed them. To prevent leakage of sclerosant into the systemic circulation, small collaterals are embolized with microcoils.
For acute bleeding from gastric varices, BRTO is used both independently and in addition to endoscopic methods, increasing their efficiency. Hemostasis is achieved in almost 100% of patients with no relapses within three years and a survival rate reaching 70%. BRTO is no less effective in preventing recurrent bleeding from gastric varices.
A potential concern is the development or progression of esophageal varices, which may be associated with increased portal pressure after this procedure. Among others side effects hemoglobinuria, abdominal pain, transient fever, pleural effusion, ascites, and temporary deterioration of liver biochemical parameters are described. Serious complications are rare. These primarily include pulmonary infarction, shock, and atrial fibrillation.
Another type of transcatheter embolotherapy is percutaneous endovascular obliteration of gastric varices. It consists of the transport introduction into the left gastric vein of a metal spiral or embolus made of Teflon felt, usually from a transhepatic or transsplenic access, which contributes to the separation of the esophageal-cardiac and portal-splenic vascular territories. Marked high efficiency this method for acute bleeding. However, due to the formation of new paths collateral blood flow in the long-term period, relapses often occur, which affects overall mortality. In this regard, it is proposed to combine percutaneous endovascular obliteration of gastric varicose veins with endoscopic sclerotherapy, or BRTO.
There are isolated reports of achieving stable hemostasis during bleeding from gastric varices in patients with segmental (left-sided) portal hypertension due to splenic vein thrombosis solely by embolization of the splenic artery with the installation of a Gianturco coil, or combining it with laparoscopic splenectomy.
Percutaneous transhepatic portal vein repair with implantation of a self-expanding metal stent, described in 2001 by K. Yamakado et al., is used in patients with extrahepatic portal hypertension caused by stenosis or occlusion of the portal vein, both benign and malignant. A few publications indicate the effectiveness of this method as a preventive measure for gastric varicose veins.

Surgical treatment

According to domestic authors, in the presence of bleeding from esophagogastric varices, the indication for urgent surgical intervention in patients with liver cirrhosis, classified according to the Child-Pugh criteria as class A and B, as well as with extrahepatic portal hypertension, is the ineffectiveness of conservative and endoscopic methods of hemostasis. In this case, the method of choice is the operation proposed by M. D. Patsiora (1959).
Surgical methods for preventing relapses variceal bleeding can be conditionally divided into shunting (various variants of portocaval anastomoses) and non-shunting (devascularizing operations of the esophagus and stomach, as well as other interventions not related to the diversion of portal blood into the inferior vena cava system). The latter do not impair liver function, however, they are mostly accompanied by a high frequency of recurrent bleeding. The most effective of them is the operation described in 1973 by M. Sugiura and S. Futagawa, which is a modification of the method of M. Hassab (1967). It requires both transthoracic and transabdominal access and includes transection and suturing of the esophagus in the lower third, extensive devascularization of the esophagus and stomach from the left lower pulmonary vein to the upper half of the stomach, splenectomy, selective vagotomy and pyloroplasty. M. Tomikawa et al. investigated the effectiveness of this intervention in 42 patients with gastric varicose veins. In the absence of surgical mortality, the five-year survival rate was 76.2%. Persistent eradication of varicose veins was observed in all cases. However, it should be noted that similar unique results were not obtained by other clinics.
Operations related to decompression portal system, contribute to reliable prevention of recurrence of variceal bleeding and consist of total, selective or partial shunting of blood from the portal to the inferior vena cava system. In the nearly 60 years since A.O. Whipple et al. performed direct portacaval shunting, questions about its feasibility have now been resolved. A significant drawback of the intervention is the total diversion of portal blood flow. Meanwhile, maintaining its constancy, as well as venous hypertension in the intestinal bed, is necessary to maintain normal metabolic processes in the liver. The consequence of this is progressive liver failure, which is accompanied by high postoperative mortality, and the resulting encephalopathy has more severe course than the original one. Despite the fact that various original modifications of the operation have been proposed, their results clinical application in most cases they turned out to be unsatisfactory.
W.D. Warren et al. in 1967 described a method that could minimize the complications inherent in total shunts. It consists of selective transsplenic decompression of esophagogastric varices through the creation of a distal splenorenal anastomosis. By reducing the pressure in the shunted section of the splenic vein, the operation effectively relieves the pressure on the gastrosplenial vascular area. However, more complex hemodynamic changes develop in the hepatoportal zone. Since portal pressure remains elevated even if it is initial values decrease with a decrease in splenic blood flow, achieve long-term separation of the two venous systems of high and low pressure through selective shunting is almost impossible. Hypertension in the portomesenteric zone after some time contributes to the formation of pronounced collateral circulation through the pancreas towards the low pressure area - the gastrosplenial vascular territory. This leads to a decrease in portal blood flow with a high probability of portal vein thrombosis. The development of the so-called “pancreatic siphon” between the portal and splenic veins worsens the results of the operation, primarily due to the progression of hepatic encephalopathy, the level of which in some cases is similar to total bypass surgery. Careful separation of collaterals makes it possible to avoid these undesirable consequences.
Partial bypass involves a side-to-side anastomosis through an H-shaped polytetrafluoroethylene graft with a diameter of 8 mm between the portal or superior mesenteric vein and the inferior vena cava. This makes it possible to achieve effective decompression of the portal system while maintaining adequate progradient blood flow. As a result, the risk of developing encephalopathy is significantly reduced, and the number of recurrent bleedings is comparable to total or selective bypass surgery.
However, the role of bypass operations in patients with gastric varices is currently not sufficiently assessed, especially in the presence of spontaneous gastrorenal anastomoses. The British Society of Gastroenterology suggests considering them as an alternative to TIPS, i.e. a “second-line” treatment measure for the prevention of recurrent bleeding from gastric varices when endoscopic methods of hemostasis are ineffective.

CONCLUSION

Treatment of patients with bleeding from gastric varices remains an important clinical problem that is far from being resolved. A number of optimistic techniques have not yet received widespread practical application. Thus, most of the described methods of interventional radiology are widespread mainly in Japan. At the world consensus conference in Baveno (Italy, 2005), dedicated to the methodology of diagnosis and therapy of portal hypertension, the following concept on this issue was defined. To treat acute bleeding and prevent their recurrence, obliteration of gastric varices with histoacryl (N-butyl-2-cyanoacrylate) is recommended. In addition, for the purpose of secondary prevention of bleeding from gastric varices, non-selective β-blockers can be used; in patients with type 2 gastroesophageal varices and isolated type 1 gastric varices, TIPS was performed; in patients with type 1 gastroesophageal varices, endoscopic ligation was performed. It was noted that further randomized controlled trials of each of the proposed methods are required to determine the optimal management of patients with gastric varices.

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

If a person notices digestive disorders, can gastric varicose veins be their cause? Unfortunately, this possibility exists. The doctor will diagnose correct diagnosis, but the time for diagnosis will be significantly reduced if the symptoms are clearly described.

Sometimes it's better to be safe, check for signs of this disease, since you still have to take tests. Many people consider research methods gastrointestinal tract unpleasant, they don’t want to go through them again. Knowing the main signs and discovering them in yourself, you can save time, nerves, money, inquire, ask a doctor, How be in this situation.

Signs of gastric varicose veins

What are varicose veins? This term is familiar to almost every person today. This disease is associated with severe psychological discomfort. Its manifestations spoil 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 enlargement, the appearance of nodes, loops, the formation of blood clots in this internal organ. The blood supply deteriorates, and accordingly, the condition of the tissues deteriorates. The digestion process is also disrupted.

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

It may be time to see a doctor. Functional disorders, appearing in connection with circumstances, situational, are characterized by transience, pathological - stability. Doctors do not always associate heartburn and belching with deformation of blood vessels; they look for other causes. And yet, there is a possibility that these are varicose veins of the stomach.

To more late symptoms refers to bleeding. You can notice it by changes in the color of the stool - it is almost black if it contains blood. The urge to vomit begins to bother me. They cannot be eliminated by changing the diet or eating foods that normalize digestion.

More on the topic: How to clean your stomach with salt water at home?

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

Who's at risk

This disease, according to statistics, is more common in men. Scientists do not know exactly what explains these statistics. Possibly anatomical and physiological characteristics floor. A woman must carry a child, and pregnancy due to upright posture may have a slight effect on the abdominal organs. A woman's body is more resistant to deformations of various tissues in this area. Natural self-regulation mechanisms also protect the blood vessels of the stomach from stretching. This is probably the reason.

Varicose veins are considered a genetically determined disease. Among the reasons for the development of pathology is systematic alcohol consumption in large quantities, unbalanced diet, frequent consumption of foods with high content cholesterol, drug use large quantities, lifting weights, chronic diseases of the digestive system.

After 50 years, the risk of developing pathology increases. There is a relationship between its appearance and general condition health. In particular, people suffering chronic diseases liver, pancreas, heart or stomach are at risk. There is a high probability of this problem occurring. Portal hypertension is a decisive factor.

Diagnosis of the disease

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

The following tests are usually performed:

  • esophagogastroscopy;
  • radiography with contrast;
  • Ultrasound of the abdominal organs;
  • general blood test;
  • advanced 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 appear in other organs for a reason. If it is found in the human stomach, this does not mean that we should expect it to appear in the esophagus. The lesion is weak point, a gap in the shell of health. Therefore, the spread of deformities throughout the body is extremely rare.

More on the topic: What to do at home if your stomach hurts?

The disease is not life-threatening. However, it shortens its duration and affects its quality. Heavy bleeding, which is highly likely to stop on its own if the problem is not treated. Doctors only help to avoid complications and prescribe those drugs that are most suitable for the patient, taking into account the clinical picture and individual characteristics. Gastric varicose veins and the disorders that make their development possible cause discomfort in the later stages and prevent a person from living a full life.

Modern methods of treatment

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

Endoscopic ligation is a minimally invasive method that gives good results. In some cases, gastric vein bypass is relevant. Sclerotherapy helps eliminate deformities. Stage of development individual characteristics, the clinical picture determines 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 can you count on recovery.

Diet is part of therapy

The diet is always prescribed. It is necessary to comply with it. Condition of the heart, blood vessels, blood and glands internal secretion involved in the digestion process will improve if food is supplied useful substances, necessary for their normal functioning.

It is imperative to reduce the portions of food consumed - the walls of the stomach should not stretch too much. This contributes to vein deformation. It is better to eat more often, but little by little. Preferably daily ration Divide into 5-6 doses and start meals at the same time. In this case, the load will decrease and become predictable and uniform.

You should exclude from your diet foods rich in bad cholesterol, steam, bake, and boil. Fried foods are its main source. Its use should be kept to a minimum. It is advisable to abandon it once and for all. Smoked, pickled, spicy, sour foods should also be excluded. Hot and cold food and drinks have a bad effect on digestion. The optimal temperature is 37-45 degrees. You should have dinner 3-4 hours before bedtime.

With varicose veins of the esophagus, an increase in the lumen of the esophageal vessels occurs due to dysfunction of the venous valves and impaired blood outflow from the superficial veins. The disease affects mainly men 45–50 years old, It is asymptomatic for a long time, so it is diagnosed only when complications develop. Esophageal varices can lead to bleeding varying intensity, anemia, death.

Causes of varicose veins

VRVP appears against the background of increased pressure in the portal or vena cava basin. Hypertension of the portal vessels leads to stagnation and disruption of outflow in the esophageal veins. As a result, varicose veins of the stomach and esophagus develop.

The provoking factors are overuse alcohol, viral, inflammatory diseases liver. When the outflow of blood is obstructed, the veins stretch, become longer and take on a tortuous shape, forming varicose veins. The walls of blood vessels lose elasticity, become thinner and can be easily injured, which leads to the development of bleeding.

Causes of esophageal varicose veins:

  • chronic hepatitis;
  • cirrhosis, tuberculosis, malignant tumors liver;
  • cardiovascular failure;
  • echinococcosis;
  • cholelithiasis;
  • Arnold-Chiari syndrome;
  • thyroid diseases;
  • congenital vascular dysplasia;
  • pancreatic tumors.

One of the main causes of the disease (70%) is considered to be chronic liver damage, the formation of scars in the tissues of the organ against the background of hepatitis, and alcoholic cirrhosis. If varicose veins are observed against the background of liver damage, then the venous nodes are localized in lower section esophagus, at the entrance to the stomach. When the patient suffers from hypertension, the nodes are smaller and are located along the entire length of the digestive canal.

Symptoms of varicose veins of the esophagus

Disease on early stages doesn't have severe symptoms, first clinical manifestations similar to signs of esophagitis. A person may be concerned about:

  • belching;
  • heaviness in the area chest;
  • difficulty swallowing food;
  • heartburn.

The bulging of blood vessels causes loosening of the mucous membranes of the esophagus, which are easily injured by solid food fragments. Soft fabrics become inflamed, causing a burning sensation, sour belching, and pain while eating.

In the second and later stages, a vascular pattern is clearly visible on the skin in the chest area (“jellyfish head”). This symptom occurs with venous hypertension and congestive processes.

Esophageal varices are characterized by fluctuations in intravascular pressure. Sudden surges cause vein rupture and bleeding. In some cases, it is insignificant and goes unnoticed, but with chronic blood loss the patient develops iron deficiency anemia. In more than half of patients, bleeding is profuse and can be fatal.

Hemorrhagic signs appear after overeating, severe physical activity, but can also develop at rest, even at night.

Symptoms of bleeding from varicose veins of the esophagus:

  • nausea, vomiting with blood;
  • general weakness;
  • black feces;
  • poor appetite;
  • pale skin;

  • increased sweating;
  • decreased blood pressure;
  • dizziness;
  • loss of consciousness.

When uncontrollable vomiting with bright scarlet blood occurs, the person feels severely unwell, dizzy, and may lose consciousness. If the patient is not provided with timely medical care and do not carry out treatment, death occurs.

Classification

Varicose veins of the esophagus can be congenital or acquired. Congenital pathology It is rare and is caused by genetic predisposition and difficult pregnancy. The acquired form develops against the background chronic lesion liver, diseases of the gastrointestinal tract, cardiovascular system.

Depending on the degree of expansion of the lumen of the veins, the disease is classified:

  • Grade 1 esophageal varicose veins are characterized by vascular ectasia up to 3 mm, single nodes are present, an abrupt narrowing of the esophagus is noted, bleeding does not develop at this stage.
  • Stage 2 varicose veins are diagnosed with tortuous, dilated veins, with a lumen diameter of no more than 3 mm. During an X-ray with contrast, defects are detected round shape with uneven contours. Bleeding may occur when mechanical damage vessels with solid food.
  • Stage 3 disease is accompanied by persistent dilation of the lumen and decreased vascular tone. There is deformation of the walls, uneven narrowing of the esophagus, and the surface of the mucous membrane changes. Multiple nodes are formed, which can be easily injured, causing bleeding. Protrusion of blue veins, areas of hyperemia and erosion are noted.
  • Varicose veins of the 4th degree are diagnosed with pronounced thinning of the mucous membrane, the presence of venous nodes in the shape of a bunch of grapes, which almost completely block the lumen of the esophagus. Bleeding occurs frequently and is accompanied by massive blood loss.

Diagnosis of the disease

Varicose veins of the esophagus and stomach are detected based on the results of ultrasound of the abdominal organs, laboratory tests. At biochemical research blood is determined:

  • liver fractions;
  • red blood cell level;
  • hemoglobin level.

Low concentration blood cells indicates periodic blood loss and the development of anemia.

Esophagoscopy and X-ray studies esophagus, stomach allow you to assess the condition of the mucous membranes digestive organs, the degree of narrowing of the tube lumen, detect varicose nodes, deformation of blood vessels.

Treatment methods

To eliminate varicose veins of the esophagus, it is necessary to establish the main cause that caused the development of the pathology. Treatment is prescribed by a gastroenterologist, cardiologist, endocrinologist or oncologist.

To eliminate bleeding and its consequences, homeostatic therapy with calcium, vitamin K, and plasma is carried out. To detect the source of perforation, FGS is done and the following is performed:

  • endoscopic clipping;
  • electrocoagulation of the damaged vein;
  • application of thrombin.

Inserting a Blackmore probe into the lumen of the esophagus stops bleeding. The device has special balloons that, when inflated, compress the bleeding vessels.

If gastric varicose veins are complicated by bleeding, treatment is carried out using endoscopic ligation, sclerosis of damaged veins, or vessels are sutured through the surface of the mucous membrane. After bleeding stops, it is indicated surgical treatment. The doctor applies a shunt between the portal vein and the vessels of the systemic bloodstream, ligates the splenic artery, portal vein, or removes damaged vessels of the esophagus.

Patients are recommended to switch to fractional meals in small portions 5–6 times a day. For liver diseases, limit the consumption of fatty, fried, spicy food. Food should be pureed, warm and free of hard pieces. Varicose veins of the esophagus are incurable, the disease has poor prognosis. Patients should be observed by their doctor, strictly follow the recommendations, eat right, and avoid heavy physical activity.