According to statistics, esophageal varicose gastrointestinal bleeding is a disease accounting for 70% of gastrointestinal bleeding in cirrhotic patients. This is a disease with high recurrence rate (up to 80%) and rapid death due to varicose hemorrhage of esophageal vein (30-35%).
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Gastrointestinal bleeding dilates esophageal veins
Currently, the proportion of patients suffering from gastrointestinal rupture of varicose esophageal veins is increasing rapidly. Some research documents show that up to 75% of patients with dilated esophagus, 40-60% varicose veins have cirrhosis, 25-35% varicose veins bleeding, 1/3 bleeding lead to death. For patients with a history of liver disease the danger is even greater because portal hypertension leads to dilated esophageal varices.
Gastrointestinal bleeding oesophageal varices is a bleeding condition caused by a rupture of a dilated tuple of the esophagus, stomach or duodenum. In it, the most part is the dilatation of the esophageal vein. When gastrointestinal bleeding ruptures esophageal veins, the patient will experience some symptoms as follows:
- Vomiting: Blood is bright red, long-flowing, reddish brown or dark brown. If the patient has heavy bleeding and bright red color is acute bleeding.
- Black stools: Stool nature depends on the degree of bleeding. If the patient bleeds 60 ml of blood, then they will have black stools such as coffee grounds, tar, with a stench, rotten smell. The patient has red stools when the blood circulation in the small intestine is fast.
- Rapid pulse, blood pressure drops
- Jaundice, ascites, enlarged spleen, cirrhosis
- Blood in the body decreased dramatically
- Pain in the epigastric region
After an endoscopy, patients with esophageal varices divided into 3 levels:
- Grade 1: The vein is very small, and when inflated, it will gradually disappear.
- Grade 2: Veins occupy <1/3 of the size of the esophagus, and will not disappear when inflated.
- Grade 3: Veins account for> 1/3 of the esophageal size and expand into chunks.
Physical examination of gastrointestinal bleeding due to varicose esophageal vein
Gastrointestinal bleeding ruptures the esophageal veins, causing heavy bleeding and serious damage to the digestive system. With gastrointestinal bleeding disease of the varicose esophagus vein, the earlier the treatment the better. Especially, when patients have cirrhosis, preventive treatment will limit the dangerous complications that can occur, affecting the health and death of the patient.
In the prophylactic treatment of dilated gastroesophageal varices in patients with cirrhosis, the doctor will prescribe gastroesophageal endoscopy so that the degree of esophageal varices can be screened. If the patient has grade 1 esophageal varices, it is necessary to conduct an endoscopy once a year. In patients with no esophageal varices and stable liver function, an endoscopy is required once every 2 years.
During the clinical examination of esophageal varicose gastrointestinal bleeding, the doctor will check for acute blood loss, symptoms of portal hypertension – cirrhosis, gastric lavage. As follows:
# Acute blood loss
This depends on the amount and rate of blood loss.
- <500ml / 15 – 30p: The patient does not have clear clinical symptoms but exhibits an organized hypoxia.
- 20% reduction of VTH (1000ml) : Patients with low blood pressure when changing positions suddenly, pale skin, pale mucosa, sweating, thirst, …
- 40% reduction (2000ml): Patients with perceptual disorders, hypotension, dyspnea, sweating, …
# Symptoms of portal hypertension – cirrhosis:
- Yellow skin, yellow eyes
- Bleeding under the skin
- Gan to
- The circulatory system is disturbed
- Fever
- Decreased urine output
# Put the stomach sonde:
It is necessary to put a gastric tube in the following cases:
- Patients with gastrointestinal bleeding, diarrhea accompanied by fresh blood.
- Bright red or dark brown gastric juice
Tests for gastrointestinal bleeding dilate esophageal veins
After a physical examination, patients with suspicion of gastrointestinal rupture of varicose esophageal veins will be ordered to perform a number of additional requirements. At this point, the doctor will ask the patient to conduct a number of tests to be able to accurately diagnose the patient’s condition and severity. Here are some tests that patients can refer to.
# CBC
People with gastrointestinal bleeding diseases rupture of esophageal veins will have a sudden decrease in Hc, Hb, He. However, if the patient bleeds rapidly, the ratio of Hc, Hb, He cannot accurately reflect the blood loss status. After a few hours or days, the body can react to retain water to compensate. At this time, the amount of Hc, Hb, He really decreases.
If it is suspected that the patient has gastrointestinal bleeding rupture of the esophageal vein, the patient will receive a blood transfusion after a physical examination. About 1 hour later, the platelets will quickly increase. After 2 – 5 hours, the neutrophils will also increase. These values will return to normal after a few days.
# ECG (electrocardiogram)
Patients with ischemic heart disease will exhibit anemia. This test will be indicated for patients> 50 years old, with a history of cardiovascular disease, hypotension, severe anemia, difficulty breathing, chest pain. If the patient has ECG changes with symptoms of myocardial anemia, it is necessary to conduct blood transfusion early.
# Other tests
- Gastroscopy: This method can help doctors diagnose and intervene in treatment early.
- Diagnostic imaging of bleeding location: Helps determine bleeding location of the patient with a speed of> 0.1 ml / min.
- Selective angiography: Detects the disease with blood loss from 0.5 to 0.6ml / min.
Treatment of gastrointestinal bleeding dilated esophageal vein
Gastroesophageal varicose gastrointestinal bleeding is a very dangerous disease that can cause many complications if the patient does not control and treat it promptly. In fact, many patients die from the disease. Patients should soon conduct examination. Depending on the severity of the disease, the doctor will prescribe the appropriate treatment for the disease. Here are the ways to cure esophageal varicose gastrointestinal bleeding diseases, patients can learn.
1. Western medicine treatment
The use of medications for gastrointestinal rupture of varicose veins of the esophagus is used for patients with mild illness and severe stomach bleeding. Depending on the severity of the disease, the doctor will prescribe the right medication. Some of the drugs used to treat gastrointestinal hemorrhage rupture of varicose veins of the esophagus are as follows:
#Non-selective β inhibitors: Nadolol, Propranolol, carvediol
This is a drug that helps to reduce portal pressure, reduce the size of the egg vein, reduce the risk of primary peritonitis, blood infection. Patients with bronchial asthma, mental disorders, chronic obstructive pulmonary disease, … are not allowed to use this drug. Besides, the patient must take the medicine continuously for life. If treatment is stopped, there is a high risk of recurrence of oesophageal varicose gastrointestinal bleeding.
# Vasodilators of the Nitrates group
This drug is a non-selective inhibitor. However, the drug was more effective than ISMN (isosorbide mononitrate). Therefore, nitrates can be selected for primary prophylaxis.
2. Endoscopy with rubber ring
This method is as effective as a preventive drug treatment. However, only certain cases can apply this treatment: patients with gastrointestinal bleeding rupture of esophageal veins at 2 – 3, patients cannot tolerate non-selective inhibitors, patients people with cirrhosis of the liver, esophageal varices.
3. Injections of esophageal varices
If the treatment of gastrointestinal bleeding rupture of the esophageal vein has heterogeneous results, the patient will be prescribed by the doctor for esophageal varicose veins. This choice will depend on the facilities available at the hospital, the patient’s condition, and the patient’s wishes.
Note:
Principles of treatment of gastrointestinal rupture of esophageal varices are active resuscitation, recovery and hemostasis, and preventive treatment of gastrointestinal re-bleeding caused by rupture of esophageal veins. Patients should comply with the treatment regimen of gastrointestinal bleeding as directed by their doctor. In addition to the above treatments, it is forbidden to combine treatment in the following cases:
- The combination of beta blockers and ISMNs is not allowed because it does not improve the effectiveness of treatment but also increases side effects.
- Do not combine laparoscopic treatment with rubber rings and varicose veins because there is no basis to support this combination.
Besides, the doctor can coordinate the treatment of 2 methods in the following cases.
- Combined use of non-selective inhibitors and ligation of the esophageal varices with rubber rings. This is the treatment chosen by the doctor because the re-bleeding results are lower than the single treatment method.
- The combination of ISMN with a non-selective chế inhibitor is highly effective in patients who do not have a hemodynamic response.
- Combination of inhibitors with ISMN for cirrhotic patients who cannot or are not ready to be treated with esophageal varicose veins
Prevention of gastrointestinal bleeding dilated esophageal vein
With gastrointestinal hemorrhage rupture of esophageal veins, prevention is essential for everyone. In order to achieve good health, people need to have a healthy lifestyle, a healthy diet and proper rest. Here are ways to prevent gastrointestinal bleeding of varicose esophageal veins, everyone can consult.
- Build a reasonable diet, fortify green vegetables and fruits with many vitamins for the body
- Limit your use of alcohol, beer, cigarettes and other stimulants
- Avoid eating processed foods that contain a lot of greasy, spicy, hot, …
- Eat foods that are thin, easy to digest, and don’t eat too hard
- Drink enough 2 liters of water per day, supplement the body with juices
- Sleep enough 8 hours a day, do not stay up late, wake up early
- Reduce stress, worry too much, work too much
- Regular exercise and sports to increase the body’s resistance. Select suitable exercises such as yoga, swimming, walking, … to support the stomach to function better.
- Split meals, do not eat too full or leave your stomach too hungry, eat on time, do not eat late, affecting the digestive system
- Check the stomach regularly for early abnormalities in the body
- Weight control, avoid overweight and obesity
Hopefully the above information will help the patient better understand the gastrointestinal rupture of the esophageal vein as well as how to treat this disease. If you find yourself having signs of illness, you should soon proceed to examination and treatment. Absolutely do not buy drugs on your own, making the disease impossible, but the bleeding becomes worse and worse, causing serious damage to other organs in the body.
