Causes
The cause of esophageal varicose vein bleeding is the rupture, i.e. tearing, of existing varicose veins in the esophagus. The vessels from which the varicose veins develop are naturally present, but under certain circumstances they develop into these widened and tortuous vessels. These varicose veins develop because the blood seeks alternative circulation back to the heart when the route via the liver is too “difficult” for it.
This is usually due to increased pressure in the hepatic veins, so that the blood backs up in front of the liver. This disease is medically known as portal vein hypertension. In order to reach the heart nevertheless, the blood seeks other routes via already existing collateral circulation.
You can find more about this disease under the topic of portal vein hypertension. Due to this extreme strain on the vessels, which are otherwise only small and exposed to little pressure, they expand and varicose veins develop. In most cases, it is not only the esophagus that is affected by esophageal varicose vein bleeding, but also other vascular systems on the way to the heart are strained (for example, the abdominal wall around the navel, the so-called caput medusae; haemorrhoids can also develop in this way).
Bleeding occurs when the already thin vessel wall is injured from the outside (for example, by solid food) or when there is increased pressure inside the vessel (this is the case, for example, when the so-called abdominal press is used for defecation (= emptying of the bowel). Since varicose veins are veins in terms of vascular structure and function, they do not have sufficiently strong vascular muscles to stop the bleeding by constriction via regulatory mechanisms. Oesophageal varices usually become symptomatic too late, namely only after bleeding from them.
The affected patients vomit blood. The blood flows from the esophagus directly into the stomach. This explains the so-called tar stools, which owe their name to their appearance.
When the hydrochloric acid of the stomach comes into contact with the fresh blood, the blood turns black due to chemical changes. Furthermore, patients in acute condition appear pale due to the high blood loss, which lowers blood pressure. This can be confirmed in the blood count.
The bleeding itself can be diagnosed differently depending on its intensity. If it is only a slight bleeding, it may not cause any symptoms. In this case, the bleeding can be noticed on the basis of the altered blood count or discovered during an endoscopic examination (swallow the tube).
The therapy for esophageal varicose vein bleeding consists of immediate hemostasis. The attending physician inserts an endoscope into the esophagus and, with the help of the integrated camera, can locate the bleeding. There are now several possibilities to stop the bleeding. Furthermore, there is also the possibility of a drug-assisted hemostasis, which is usually relatively rarely used.
- In the case of acute massive bleeding, a probe is inserted into the oesophagus, which is compressed from the inside via a so-called balloon catheter so that the bleeding stops.
- A tissue adhesive can also be applied.
- The leaking area in the vessel is sucked up and wrapped with a loop, which is then closed.
- Bleeding can also be indirectly reduced by lowering the pressure in the liver nervous system.
