Esophageal varices is a term for a venous dilation in the lower part of the esophagus, resulting from disturbances in the flow of blood in the portal vein, and therefore the gastroesophageal plexus, by excessive flow of blood that seeks outflow from the heart..

The most common and most dangerous symptom of esophageal varices is associated with hemoptysis, vomiting mixed with blood, tarry stools and weakness..

Due to the fact that varicose veins of the esophagus in 90% of cases correspond to cirrhosis of the liver, yellowing of the skin and whites of the eyes, loss of appetite, weight loss, ascites, abdominal pain and nausea may occur..

Medical treatment is the main method used to reduce pressure in the hepatic vascular system, while interventional treatment of bleeding requires endoscopic creation of clamps to control bleeding.. The main treatment is aimed at permanent protection against new hemorrhages by a method that creates system decompression..

Clinical manifestations and course.

Often the first symptom of esophageal varices is the most serious complication - bleeding from esophageal varices.. Most of the other symptoms are related to the underlying disease leading to hypertension..

Diagnosis of varicose veins of the esophagus.

Esophagoscopy - examination of the esophagus.

Contrast fluoroscopy of the esophagus.

The degree of varicose veins of the esophagus.

I degree - narrow varicose veins in a simple course.

II degree - dilated varicose veins in a tortuous course, occupying less than 1/3 of the circumference of the esophagus.

III degree - wide varicose veins in a tortuous course, which occupies more than 1/3 of the circumference of the esophagus.

Complications.

The most dangerous complication of varicose veins of the esophagus is bleeding.. It can occur very abruptly, and this can lead to a large loss of blood.. Manifested in hemoptysis and vomiting of fresh blood. Vomiting is due to the direct action of blood. Approximately 30% of bleeds are fatal. Death occurs both due to blood loss and as a result of liver coma.. Coma occurs due to an overload of large amounts of proteins.

Forecast.

Patients who have already had one episode of variceal bleeding have a 70% chance of rebleeding in the near future. Approximately 30% of subsequent bleeding is fatal. Death occurs on the day of bleeding or a few days after.

Treatment of varicose veins of the esophagus.

Treatment can be divided into three stages: conservative treatment of esophageal varices, palliative treatment of varices from which bleeding has been observed, and interventional treatment of bleeding. In conservative treatment, non-selective receptor blockers, beta-adrenergic receptors (beta-blockers), for example, propranolol, which reduces cardiac output, reduces blood flow to the portal system.

Palliative care is used to prevent recurrence of bleeding. It consists in forming a port for the anastomoses (between the portal vein and others), which allows bypassing the flow of blood through the liver and, as a result, reducing the pressure in the portal vein.

Interventional treatment of bleeding consists in the endoscopic introduction of an agent (usually polidocanol) to the site of bleeding or the creation of clamps on bleeding varicose veins. An older method, now rarely used, is the creation of Sangstaken-Blackmore or Minnesota-Linton probes for tamponade..

In the case of massive hemorrhage, intravenous growth hormone analogs (octreotide) can be administered, which, by causing spasm of the visceral arteries, reduces the amount of blood flowing to the varicose veins and facilitates the work of endoscopy. You can also use terlipressin.

medbe. en.