Esophageal bleeding occurs due to damage portocaval anastomosis (anastomoses between the portal vein and hollow) located in the body wall. The condition occurs suddenly, causing great loss of blood, and if first aid is not provided in a timely manner can result in death. Pathology often accompanies the disease, the symptoms of which are trophic changes in the digestive tract and decrease blood clotting.
Causes
The most common bleeding from the esophagus occurs due to varicose veins. Because congestive processes reverse blood flow is disturbed, the vessels are stretched, are izvivistymi and their walls become thinner. Any mechanical effects (vomiting, physical strain, ingestion of poorly chewed food or inspection with a probe) can cause vascular injury.
There are other causes of esophageal bleeding:
- hepatic cirrhosis and hepatic failure;
- Gastrointestinal diseases: angioma, benign tumor, gastric ulcer or duodenal ulcer;
- Maallori-Weiss syndrome, wherein the step of reverse peristalsis (vomiting) longitudinal gaps appearing mucosa lining the esophagus;
- Rendu-Osler disease - a genetic disease, based on the abnormal structure of the vessels;
- oncological processes germination metastases vein;
- throat injury and sometimes chest;
- burns and alcohol abuse;
- venous abnormalities (narrowing of the hepatic portal and vices);
- intestinal infections;
- stress factors and long-term emotional instability.
In heart failure, there are failures in the body venous system, when the upper structure is broken struma thyroid arteries, and liver cirrhosis - the lower vena cava.
Symptoms and Diagnosis
The first signs of digestive bleeding, felt by patients:
- itching and irritation in the throat, which is characterized as a tickle;
- iron taste in the mouth;
- hematemesis, which may be or scarlet color of coffee grounds with undigested food fragments.
Later, there are other signs: blood pressure decreases, there are weakness and dizziness, pulse quickens. If you lost a lot of blood, there is a faint and dizzy. 1-2 days stool color is black. Such cal called melena.
Suspected esophageal bleeding your doctor may, after a patient survey, assessing the clinical picture. You must put a doctor aware if there are cardiovascular disease, blood disease or abnormal liver function.
To confirm the diagnosis may be required to take a blood test for hemoglobin. It is important to coagulation, biochemistry, fecal occult blood, to make FGS or X-rays with contrast injection. Laboratory tests give an indication of the severity and extent of blood loss and the state of the liver. The exact cause of the disease will help to establish an MRI or CT scan.
Treatment and prevention
Profuse bleeding esophagus eliminated in the hospital. If the blood loss is insignificant, hospitalization is not required. Complex therapeutic intervention aimed at restoring vascular integrity, compensation physiological fluid and prevent dehydration.
endoscopic method
Minimally invasive surgery for excessive bleeding is performed in a hospital, with a slight - an outpatient basis. Local anesthesia. The throat of the patient is administered an endoscope by which the detected location of varicose veins. Further treatment method determined by the physician:
- For small hemorrhages cauterize bleeding vessels electric current via electrodes.
- Assign ligation when varices compress the silicone ring (ligatures). During a manipulation can be installed up to 30 rings. When arresting bleeding tissue ischemia occurs first, followed by necrosis. 6-7 days after the procedure nodes are reduced, ligature moves down the esophagus into the stomach, and then eliminated from the body naturally.
After endoscopic surgery of the mucous scars remain, but the body lumen is not narrowed.
sclerotherapy
This procedure is also carried out with the help of an endoscope. It is mounted on a syringe with drugs, which are called sclerosant. The operation is performed in two ways:
- The traditional method involves the introduction of medication directly into the veins, after which they are glued, and blood flow is redistributed through other vessels.
- A more recent technique is that the drug is introduced into the submucosa. There is swelling, compressing the affected vessel, and the bleeding stops. Due to the formation of scar skeleton due to connective tissue growth reduced the risk of relapses.
Gemostatistichesky method
If profuse bleeding does not apply because for vascular regeneration takes time. Prescribe medications that increase blood clotting, production of protective mucus on the walls of the esophagus and normalize the acidity of gastric juice, and vasoconstrictors that reduce blood pressure and cause spasms of the small arteries (Arterioles). Accordingly, the reduced flow of blood to the veins, and due to reduced load regeneration of organic tissues is accelerated.
For drugs, vasoconstrictors include vasopressin, Sandostatin.
To compensate for blood loss to the patient drip administered plasma preparations or packed red blood cells, saline solutions. Antibiotics may be necessary to prevent the inflammatory process.
It may need administration of adhesive compositions. They are introduced into the damaged vessel under endoscopic control. Rapid polymerization causes clogging (obliteration) damaged veins.
Surgery
Surgical procedures are now performed open seldom due to traumatic high, the risk of complications and long recovery period. Most held sensing when administered via the jugular vein shunt between the branches of the hepatic and portal. The double chamber silicone probe (Blackmore) is administered as an immediate relief of massive bleeding into the esophagus, compressing the affected vessel.
Another type of surgery called Beye operation that is often carried out at a hemorrhage, accompanying syndrome Maallori-Weiss. The method is based excising and suturing bleeding cracks in damaged vessels.
Forecast and consequences
When bleeding in the esophagus causes are the mechanical injury, recovery prognosis is favorable. If the damage portion is small and slight hemorrhage, regeneration occurs within 7-10 days.
After helping the patient will have a long time to diet. The burden on the digestive organs is reduced as much as possible: the food is ground and take 5-6 times a day in small portions. Food can not be heated above body temperature. Allowed boiling, stewing, steaming products. Avoid strenuous exercise and possibly stressful situations. Within 1-2 years need regular advice gastroenterologist, vascular surgery and hepatology.
If the pathology is caused by varicose veins or liver cirrhosis, likelihood of recurrence is 55-75%. In a case where a history of hypertension with frequent hypertensive attacks, the probability of death increased to 82%. When profuse bleeding survival rate is 20%.
