Varicose veins in the stomach are dilated and tortuous blood vessels that form on the wall of this organ, and can be severe, because as they become larger, they are at risk of breaking and causing serious bleeding.
These varicose veins can form in the stomach due to increased resistance of blood flow in the portal vein, an important vein that drains blood from the abdominal organs, which can arise from various causes such as chronic hepatitis, cirrhosis of the liver, schistosomiasis or a thrombosis in the portal vein, for example.
Gastric varicose veins usually arise after or in conjunction with varicose veins in the esophagus, as well as from the rectum. Treatment for these varicose veins is indicated both to prevent and to stop bleeding, and can be done with beta-blocker remedies or surgical procedures such as sclerotherapy, cyanoacrylate or elastic ligatives, for example.
How to identify
Gastric varicose veins may not cause any symptoms, and are identified on examinations when portal hypertension is suspected due to cirrhosis of the liver, for example. Esophageal varicose veins are the most common, however, varicose veins in the stomach can form in 20% of cases, especially when increased pressure in the portal vein becomes more severe.
In addition, gastric varicose veins are less likely to rupture compared to esophageal varicose veins, however, they cause a more severe and difficult to control bleeding. Some of the symptoms that indicate bleeding from varicose veins are:
- Blackened and foul-smelling feces;
- Vomiting with blood;
- Pallor, dizziness and palpitations.
Classification of types
The main test to diagnose esophageal varicose veins is digestive endoscopy. They can be in different locations in the stomach, being classified as:
Classification of gastric varicose veins
- They are a continuation of esophageal varicose veins, extending a few centimeters below the esophagogastric transition, by the small curvature of the stomach, the most common being;
- They are also an extension of esophageal varicose veins, but towards the gastric fundus;
- They are isolated gastric varicose veins, located at the bottom of the stomach;
- They are also isolated gastric varicose veins, which can arise anywhere else in the stomach.
Gastric varicose veins are considered small when they measure less than 3 mm in diameter, medium when they are between 3 and 5 mm or large, when they measure more than 5 mm in diameter. The larger the size of varicose veins, the greater the risk of bleeding.
What causes gastric varicose veins
Varicose veins in the stomach are formed by increased pressure in the Porta vein, and the main reasons are:
- Chronic hepatitis;
- Liver cirrhosis;
- Portal vein or splenic vein thrombosis;
- Budd-Chiari syndrome.
- Malformations in the Portal vein or inferior vena cava.
Varicose veins in the stomach can also be caused by a heart disease called constrictive pericarditis, in which fibrous tissue develops around the heart, and hinders its function.
How treatment is done
If varicose veins are small in size or if the doctor detects that there is a low risk of bleeding, there is no need for treatment of gastric varicose veins, only their regular follow-up.
However, the doctor may, in some cases, indicate a treatment to prevent sagramento, especially if they measure more than 10 mm in diameter or there is a serious risk of bleeding, which can be done with beta-blocking drugs, which decrease the strength of blood flow, such as Propranolol, or else the application of Cyanoacrylate, a kind of glue that eliminates the vessel.
When gastric varicose veins have bleeding, treatment may include endoscopy for sclerotherapy, cyanoacrylate injection or placement of elastic bandages, clips or springs, for example.
In addition to stopping bleeding, as this is a serious situation, and the doctor should have someonens care to protect the life of the patient, such as replenishing fluids with serum in the vein, doing blood transfusion if necessary, or using antibiotics to prevent abdominal infections, common in patients with cirrhosis of the liver.