Gullet varicosity – the pathology of ezofagealny veins which is characterized by their izvitost and meshotchaty expansion due to formation of fleboektaz. Damage of a liver, heart and other bodies can serve as the reason of this disease. Most often gullet varicosity is not shown before emergence of the most terrible complication in any way – bleedings. The main method of diagnosis of varicosity – EGDS in the course of which the medical hemostasis is made. Also treatment includes conservative actions: therapy of the main disease, medicamentous stop of bleeding. At inefficiency of therapeutic actions the shunting operation is performed.
Gullet varicosity (gullet VRV) – the pathology of its venous system developing owing to increase in pressure in system of a vorotny or hollow vein. Vessels of a gullet are closely connected with venous system of abdominal organs and, first of all, with system of a vorotny vein. Increase in pressure in a portal vein leads to violation of outflow and stagnation of blood in ezofagealny veins, provoking development of varicosity. In recent years the frequency of detection of portal hypertensia considerably increased that is connected with prevalence of viral hepatitises, other diseases of a liver, alcoholism. Danger of this pathology is that about a half of patients perishes already at the first bleeding. The risk of repeated gemorragiya is very high, and mortality reaches 80%. The disease is incurable, it is possible to increase life expectancy only at regular inspection and holding actions for the prevention of bleedings. At emergence of the first symptoms of a disease the subsequent survival makes usually no more than several years.
Gullet VRV reasons
The reasons of varicosity of a gullet are often connected with increase in pressure in system of a portal vein, much less often fleboektaziya develop against the background of system hypertensia (hypertension) or congenital pathology. Most often pressure in v.portae increases at cirrhosis or other heavy hepatic pathology, tumors of a liver or pancreas which squeeze a vorotny vein, portal thrombosis or anomalies of development. At the same time blood is dumped from system of a vorotny vein on through stomach vessels in gullet veins owing to what pressure in them considerably increases. As esophageal veins are located in friable cellulose, and walls their very thin, at an overload blood volume they stretch with formation of varicosity. At damage of a liver varicose knots most often settle down in the lower department of a gullet and at an entrance to a stomach while at system hypertensia knots smaller and are located usually on all length of body. Also varicosity can be created at a sdavleniye of the top hollow vein, at severe damage of a thyroid gland, Kiari's syndrome. VRV of a gullet of the man after 50 years are more subject.
Gullet VRV symptoms
Bleeding from gullet fleboektaz Occasionally patients happens the first symptom of a disease often can note emergence of pressure sense and weight behind a breast some days before the beginning of hemorrhagic complications. Sometimes precedes bleeding ezofagit – because of proximity of a vascular wall mucous becomes friable, it is easily damaged by firm food, inflames. At the same time the burning sensation, heartburn and an eructation sour, difficulties when swallowing dense food can disturb the patient.
Normal pressure in esophageal veins usually does not exceed 15 mm Hg, at varicosity it can increase considerably. Achievement of the level of 25 mm Hg is critical. At the same time pressure figure, how many the expressed fluctuations of this indicator matters not so much. 60% of patients can have an insignificant bleeding, but approximately it massive, leads to considerable deterioration in a state or death. Most often hemorrhagic manifestations arise against the background of fluctuations of pressure – after physical activity, an overeating, is frequent in a dream. Constant insignificant blood losses can not be shown by the expressed symptomatology, but lead to exhaustion and iron deficiency anemia. Such bleedings are followed by vomiting with blood streaks, nausea, weakness, meleny (a black chair because of impurity of the turned blood), weight reduction. If bleeding massive, at the patient arises plentiful bloody vomiting, strong weakness, consciousness violations, perspiration, pressure goes down along with increase in heart rate.
Diagnostics of VRV of a gullet
Inspection concerning diseases of a liver allows to find decrease in level of hemoglobin against the background of bleeding. Ultrasonography of abdominal organs, MRT of a liver help to reveal a background disease which led to formation of a varicosity of a gullet. The gullet X-ray analysis with introduction of contrast substance gives the chance to define its narrowing and the deformation of walls caused by protrusion of varicose knots in a gleam of an esophageal tube.
The most informative method of diagnosis of varicosity of a gullet is the ezofagogastroduodenoskopiya – at survey of a gleam of body via the endoscope bluish nodal protrusions of veins are visible. At inspection against the background of profuzny bleeding to define its source can be difficult. EGDS allows to expose the correct diagnosis, to define degree of varicosity and danger of a rupture of a fleboektaz, to hold medical events. It is necessary to remember also that bleeding against the background of a fleboektaziya of a gullet can develop from other departments of a GIT (for example, gastrointestinal bleeding) and because of other reasons: tumors of a GIT, stomach ulcer, pathology of the curtailing system of blood (trombotsitopeniye, Villebrand's disease, hemophilia, trombotsitopenichesky purples), Mellori-Weiss's syndrome, etc.
Treatment of VRV of a gullet
Depending on disease symptoms the patient can be under observation in office of gastroenterology or surgery. A task of the gastroenterologist is treatment of the main disease and the prevention of development of bleeding. For this purpose the patient receives haemo static medicines, antatsida, vitamins. Without fail perform prevention of an esophageal reflux. Recommend strict observance of the correct diet, rest and physical activities.
At development of bleeding carry out haemo static therapy – appoint calcium medicines, vitamin K, freshly frozen plasma. Make the emergency ezofagoskopiya for establishment of a source of a gemorragiya and endoscopic clipping of the bleeding vein, drawing a glue film and thrombin, electrothermic coagulation of a vessel. Apply introduction of the probe of Blackmore to a stop of bleeding – it has special cylinders which at inflation block a gleam of a gullet and squeeze vessels. However even after these manipulations in 40-60% of cases the positive effect is not reached.
After a stop of bleeding and stabilization of a state apply surgical methods of treatment – their efficiency much higher, than at conservative methods. Usually expeditious treatment consists in imposing of shunts between a portal vein and a system blood-groove thanks to which pressure in a vorotny vein decreases and the probability of bleeding becomes minimum. The safest and popular method is the endovascular transjyugulyarny method of imposing of the shunt (access through a jugular vein), also impose portokavalny and splenorenalny anastomoza, practice removal of a spleen, bandaging of unpaired and vorotny veins, a splenic artery and a proshivaniye or removal of veins of a gullet.
Forecast and prevention of VRV of a gullet
The forecast of a disease adverse – varicosity of a gullet is incurable, at emergence of this disease all measures for prevention of progressing of pathology and fatal bleedings have to be undertaken. Even for the first time the arisen bleeding significantly burdens the forecast, reducing life expectancy to 3-5 years.
The only method of prevention of a varicosity of esophageal veins is the prevention and timely treatment of the diseases provoking this pathology. If in the anamnesis there is a liver disease which can lead to cirrhosis and increase in pressure in a portal vein, the patient has to undergo regularly inspection at the gastroenterologist for timely identification of expansion of vessels of a gullet.
At the created varicosity it is necessary to keep to a strict diet: food has to be steamed or cooked, it is desirable to wipe food and not to use dense products in the form of big pieces. It is not necessary to accept dishes too cold or hot, rough and firm food for prevention of a travmatization mucous a gullet. For prevention of a reflux of contents of a stomach in a gullet the headboard of a bed is raised during sleep. To avoid bleedings, recommend to exclude heavy physical activities and heavy lifting.