{"id":17316,"date":"2026-03-02T21:39:29","date_gmt":"2026-03-02T20:39:29","guid":{"rendered":"https:\/\/valintermed.com\/?p=17316"},"modified":"2026-03-02T21:39:29","modified_gmt":"2026-03-02T20:39:29","slug":"varikoznoe-rasshirenie-ven-pischevoda-simptomy-i-lechenie","status":"publish","type":"post","link":"https:\/\/valintermed.com\/en\/medlibrary\/varicose-dilation-of-the-esophageal-veins-symptoms-and-treatment\/","title":{"rendered":"Esophageal varices: symptoms and treatment"},"content":{"rendered":"<div class=\"fpm_start\"><\/div>\n<p>Esophageal varices are not just a \"vein problem,\" but a serious complication that most often occurs against the background of liver cirrhosis or portal hypertension.<\/p>\n<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_83 counter-flat ez-toc-counter ez-toc-light-blue ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Content<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewbox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewbox=\"0 0 24 24\" version=\"1.2\" baseprofile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 eztoc-toggle-hide-by-default' ><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/valintermed.com\/en\/medlibrary\/varicose-dilation-of-the-esophageal-veins-symptoms-and-treatment\/#%D0%9A%D0%BB%D0%B0%D1%81%D1%81%D0%B8%D1%84%D0%B8%D0%BA%D0%B0%D1%86%D0%B8%D1%8F_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F_%D0%BF%D0%BE_%D0%9C%D0%9A%D0%91-10\" >Classification of the disease according to ICD-10<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/valintermed.com\/en\/medlibrary\/varicose-dilation-of-the-esophageal-veins-symptoms-and-treatment\/#%D0%98%D1%81%D1%82%D0%BE%D1%80%D0%B8%D1%8F_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F_%D0%B8_%D0%B8%D0%BD%D1%82%D0%B5%D1%80%D0%B5%D1%81%D0%BD%D1%8B%D0%B5_%D0%B8%D1%81%D1%82%D0%BE%D1%80%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%B8%D0%B5_%D1%84%D0%B0%D0%BA%D1%82%D1%8B\" >History of the disease and interesting historical facts<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/valintermed.com\/en\/medlibrary\/varicose-dilation-of-the-esophageal-veins-symptoms-and-treatment\/#%D0%AD%D0%BF%D0%B8%D0%B4%D0%B5%D0%BC%D0%B8%D0%BE%D0%BB%D0%BE%D0%B3%D0%B8%D1%8F_%D1%81%D1%82%D0%B0%D1%82%D0%B8%D1%81%D1%82%D0%B8%D0%BA%D0%B0_%D0%B2%D0%BE%D0%B7%D0%BD%D0%B8%D0%BA%D0%BD%D0%BE%D0%B2%D0%B5%D0%BD%D0%B8%D1%8F_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F\" >Epidemiology (statistics of disease occurrence)<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/valintermed.com\/en\/medlibrary\/varicose-dilation-of-the-esophageal-veins-symptoms-and-treatment\/#%D0%93%D0%B5%D0%BD%D0%B5%D1%82%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%B0%D1%8F_%D0%BF%D1%80%D0%B5%D0%B4%D1%80%D0%B0%D1%81%D0%BF%D0%BE%D0%BB%D0%BE%D0%B6%D0%B5%D0%BD%D0%BD%D0%BE%D1%81%D1%82%D1%8C_%D0%BA_%D0%B4%D0%B0%D0%BD%D0%BD%D0%BE%D0%BC%D1%83_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8E\" >Genetic predisposition to this disease<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/valintermed.com\/en\/medlibrary\/varicose-dilation-of-the-esophageal-veins-symptoms-and-treatment\/#%D0%A4%D0%B0%D0%BA%D1%82%D0%BE%D1%80%D1%8B_%D1%80%D0%B8%D1%81%D0%BA%D0%B0_%D0%B2%D0%BE%D0%B7%D0%BD%D0%B8%D0%BA%D0%BD%D0%BE%D0%B2%D0%B5%D0%BD%D0%B8%D1%8F_%D0%B4%D0%B0%D0%BD%D0%BD%D0%BE%D0%B3%D0%BE_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F\" >Risk factors for the development of this disease<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/valintermed.com\/en\/medlibrary\/varicose-dilation-of-the-esophageal-veins-symptoms-and-treatment\/#%D0%94%D0%B8%D0%B0%D0%B3%D0%BD%D0%BE%D1%81%D1%82%D0%B8%D0%BA%D0%B0_%D0%B4%D0%B0%D0%BD%D0%BD%D0%BE%D0%B3%D0%BE_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F\" >Diagnosis of this disease<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/valintermed.com\/en\/medlibrary\/varicose-dilation-of-the-esophageal-veins-symptoms-and-treatment\/#%D0%9B%D0%B5%D1%87%D0%B5%D0%BD%D0%B8%D0%B5\" >Treatment<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/valintermed.com\/en\/medlibrary\/varicose-dilation-of-the-esophageal-veins-symptoms-and-treatment\/#%D0%A1%D0%BF%D0%B8%D1%81%D0%BE%D0%BA_%D0%BB%D0%B5%D0%BA%D0%B0%D1%80%D1%81%D1%82%D0%B2_%D0%BF%D1%80%D0%B8%D0%BC%D0%B5%D0%BD%D1%8F%D0%B5%D0%BC%D1%8B%D1%85_%D0%B4%D0%BB%D1%8F_%D0%BB%D0%B5%D1%87%D0%B5%D0%BD%D0%B8%D1%8F_%D0%B4%D0%B0%D0%BD%D0%BD%D0%BE%D0%B3%D0%BE_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F\" >List of medications used to treat this disease<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/valintermed.com\/en\/medlibrary\/varicose-dilation-of-the-esophageal-veins-symptoms-and-treatment\/#%D0%9C%D0%BE%D0%BD%D0%B8%D1%82%D0%BE%D1%80%D0%B8%D0%BD%D0%B3_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F\" >Disease monitoring<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/valintermed.com\/en\/medlibrary\/varicose-dilation-of-the-esophageal-veins-symptoms-and-treatment\/#%D0%92%D0%BE%D0%B7%D1%80%D0%B0%D1%81%D1%82%D0%BD%D1%8B%D0%B5_%D0%BE%D1%81%D0%BE%D0%B1%D0%B5%D0%BD%D0%BD%D0%BE%D1%81%D1%82%D0%B8_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F\" >Age-related features of the disease<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/valintermed.com\/en\/medlibrary\/varicose-dilation-of-the-esophageal-veins-symptoms-and-treatment\/#%D0%92%D0%BE%D0%BF%D1%80%D0%BE%D1%81%D1%8B_%D0%B8_%D0%BE%D1%82%D0%B2%D0%B5%D1%82%D1%8B\" >Questions and Answers<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/valintermed.com\/en\/medlibrary\/varicose-dilation-of-the-esophageal-veins-symptoms-and-treatment\/#%D0%A2%D0%B8%D0%BF%D0%B8%D1%87%D0%BD%D1%8B%D0%B5_%D0%BE%D1%88%D0%B8%D0%B1%D0%BA%D0%B8_%D0%B8_%D0%BA%D0%B0%D0%BA_%D0%B8%D1%85_%D0%B8%D0%B7%D0%B1%D0%B5%D0%B6%D0%B0%D1%82%D1%8C\" >Typical mistakes and how to avoid them<\/a><\/li><li class='ez-toc-page-1'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/valintermed.com\/en\/medlibrary\/varicose-dilation-of-the-esophageal-veins-symptoms-and-treatment\/#%D0%97%D0%B0%D0%BA%D0%BB%D1%8E%D1%87%D0%B5%D0%BD%D0%B8%D0%B5\" >Conclusion<\/a><\/li><\/ul><\/nav><\/div>\n<h2><span class=\"ez-toc-section\" id=\"%D0%9A%D0%BB%D0%B0%D1%81%D1%81%D0%B8%D1%84%D0%B8%D0%BA%D0%B0%D1%86%D0%B8%D1%8F_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F_%D0%BF%D0%BE_%D0%9C%D0%9A%D0%91-10\"><\/span>Classification of the disease according to ICD-10<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>In the International Classification of Diseases, 10th Revision (ICD-10), esophageal varices are coded as <strong>I85.0<\/strong> \u2014 \"Esophageal varices without bleeding\" and <strong>I85.1<\/strong> \u2014 \"Esophageal varices with bleeding.\" These codes belong to the section \"Diseases of the circulatory system,\" subsection \"Varicose diseases of veins.\" It is important to understand: ICD-10 does not consider esophageal varices as an independent disease, but always associates it with the underlying pathological process \u2014 more often with portal hypertension (code <strong>K76.6<\/strong>). Therefore, when filling out medical documentation, the doctor must indicate both the primary cause (for example, liver cirrhosis \u2014 <strong>K74.6<\/strong>), and the secondary complication \u2014 esophageal varices.<br \/>\nThis has practical significance: if the medical history only states \"esophageal varices,\" but does not indicate that it is due to portal hypertension, the insurance company may refuse to pay for treatment. And during hospitalization, the code for the primary disease determines the type of department and therapy protocol. There is also a separate code for gastric varices in ICD-10 (<strong>I85.2<\/strong>), which often coexists with esophageal varices \u2014 the so-called \"gastroesophageal varices,\" and its presence sharply increases the risk of recurrent bleeding after endoscopic treatment.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"%D0%98%D1%81%D1%82%D0%BE%D1%80%D0%B8%D1%8F_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F_%D0%B8_%D0%B8%D0%BD%D1%82%D0%B5%D1%80%D0%B5%D1%81%D0%BD%D1%8B%D0%B5_%D0%B8%D1%81%D1%82%D0%BE%D1%80%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%B8%D0%B5_%D1%84%D0%B0%D0%BA%D1%82%D1%8B\"><\/span>History of the disease and interesting historical facts<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The first description of esophageal varices dates back to the works of the ancient Greek physician Galen (2nd century AD), who noted \"nodular vessels in the throat area\" in patients with ascites and jaundice. However, the true nature of the pathology remained a mystery until the 19th century. In 1840, French pathologist Jean L\u00e9caine first established a link between splenomegaly, ascites, and dilated esophageal veins \u2014 he called it \"portal hypertension,\" although the mechanism was unclear.<br \/>\nA real breakthrough occurred in the 1930s when American surgeon Ralph Blalock developed a method for measuring pressure in the portal vein through the spleno-renal anastomosis. This allowed for a quantitative assessment of the degree of portal hypertension and explained why the esophageal veins dilate: the pressure in the portal system exceeds 10 mm Hg, and blood seeks \"detours\" \u2014 through the esophageal veins, which connect to the inferior vena cava system. An interesting fact: in the USSR in the 1950s, at the clinic of Academician N.N. Petrov (St. Petersburg), the world's first specialized service for the prevention of bleeding from varicose veins was established \u2014 they were the first to apply ligation of veins through an endoscope, even before the advent of modern sclerosing agents.<br \/>\nAnother curious point: in military medicine during the Great Patriotic War, doctors noticed that soldiers with chronic liver diseases (often due to hepatitis A or toxic exposure) experienced a sharp increase in the frequency of esophageal bleeding under conditions of stress and malnutrition. This became one of the triggers for studying the role of environmental factors in the progression of portal hypertension.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"%D0%AD%D0%BF%D0%B8%D0%B4%D0%B5%D0%BC%D0%B8%D0%BE%D0%BB%D0%BE%D0%B3%D0%B8%D1%8F_%D1%81%D1%82%D0%B0%D1%82%D0%B8%D1%81%D1%82%D0%B8%D0%BA%D0%B0_%D0%B2%D0%BE%D0%B7%D0%BD%D0%B8%D0%BA%D0%BD%D0%BE%D0%B2%D0%B5%D0%BD%D0%B8%D1%8F_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F\"><\/span>Epidemiology (statistics of disease occurrence)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>According to the World Health Organization (WHO, 2024), the global prevalence of liver cirrhosis is about 0.27% of the population, and among individuals over 50 years old \u2014 up to 1.2%. At the same time, esophageal varices are found in 30\u201360% of these patients depending on the stage of the disease. In Russia, the situation is more complicated: according to statistics from the Ministry of Health of the Russian Federation (2025), about 120,000 new cases of liver cirrhosis are registered annually, and almost 70,000 of them are diagnosed with esophageal varices. The dynamics among young people is particularly alarming: over the past 5 years, the number of patients aged 30\u201340 with this complication has increased by 28% \u2014 the main reason is the rise in alcohol consumption and the spread of viral hepatitis C (although its prevalence is decreasing thanks to new antiviral drugs).<br \/>\nAs for mortality: without preventive treatment, the first episode of bleeding from esophageal varices ends in death in 20\u201330% of cases. Even with timely hospitalization and modern therapy, mortality during the acute period remains at 10\u201315%. However, if a patient undergoes preventive endoscopic ligation, the risk of recurrent bleeding decreases to 15\u201320% within a year. The table below contains summary data on epidemiology:<\/p>\n<table border=\"1\" cellpadding=\"5\" cellspacing=\"0\">\n<tr>\n<td><strong>Indicator<\/strong><\/td>\n<td><strong>Figure<\/strong><\/td>\n<td><strong>Source<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Prevalence of esophageal varices in cirrhosis<\/td>\n<td>30\u201360 %<\/td>\n<td>European Association for the Study of the Liver (EASL, 2023)<\/td>\n<\/tr>\n<tr>\n<td>Annual risk of bleeding without prophylaxis<\/td>\n<td>5\u201315 %<\/td>\n<td>Russian clinical guidelines, 2024<\/td>\n<\/tr>\n<tr>\n<td>Mortality with first bleeding<\/td>\n<td>20\u201330 %<\/td>\n<td>Journal \"Hepatology\", No. 2, 2025<\/td>\n<\/tr>\n<tr>\n<td>Effectiveness of prophylactic ligation<\/td>\n<td>reduction of bleeding risk to 15 %<\/td>\n<td>Cochrane meta-analysis, 2024<\/td>\n<\/tr>\n<tr>\n<td>Proportion of patients with varicose veins who are unaware of their diagnosis<\/td>\n<td>up to 40 %<\/td>\n<td>Study by the Federal State Budgetary Institution \"N.I. Pirogov Emergency Medicine Research Center\", 2025<\/td>\n<\/tr>\n<\/table>\n<p>Note: the majority of patients learn about esophageal varices only after the first bleeding \u2014 that is, already at the stage of complications. This indicates that screening in at-risk groups (for example, in chronic hepatitis or ascites) should be mandatory, not optional.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"%D0%93%D0%B5%D0%BD%D0%B5%D1%82%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%B0%D1%8F_%D0%BF%D1%80%D0%B5%D0%B4%D1%80%D0%B0%D1%81%D0%BF%D0%BE%D0%BB%D0%BE%D0%B6%D0%B5%D0%BD%D0%BD%D0%BE%D1%81%D1%82%D1%8C_%D0%BA_%D0%B4%D0%B0%D0%BD%D0%BD%D0%BE%D0%BC%D1%83_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8E\"><\/span>Genetic predisposition to this disease<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>There is no direct \"gene for esophageal varices\" \u2014 it is a secondary complication, so genetics plays an indirect but important role here. The most studied genes affect the development of the underlying disease \u2014 liver cirrhosis or portal hypertension. For example, a mutation in the gene <strong>HFE<\/strong> (on chromosome 6) leads to hereditary hemochromatosis \u2014 an excess of iron in the liver, which in 70 % of cases ends with cirrhosis and, consequently, esophageal varices. Another example is a mutation in the gene <strong>ATP7B<\/strong>, responsible for Wilson's disease: in it, copper accumulates in the liver, causing inflammation and fibrosis.<br \/>\nThere is also data on the polymorphism of the gene <strong>PNPLA3<\/strong> (patatin-like phospholipase 3): carriers of the variant rs738409 (G-allele) have a 3 times higher risk of developing fatty hepatitis and cirrhosis at the same level of alcohol or obesity. A study published in \"Genetics\" (2023) showed that such patients develop esophageal varices 2\u20133 years earlier than those without this mutation.<br \/>\nImportant: genetic testing is not routine when esophageal varices are suspected, but if the patient has a family history of hemochromatosis, Wilson's disease, or early cirrhosis, molecular screening should be considered. This is especially relevant for young people without obvious causes of liver damage (for example, without alcoholism or viral hepatitis). In such cases, genetic analysis helps to diagnose earlier than irreversible fibrous transformation develops.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"%D0%A4%D0%B0%D0%BA%D1%82%D0%BE%D1%80%D1%8B_%D1%80%D0%B8%D1%81%D0%BA%D0%B0_%D0%B2%D0%BE%D0%B7%D0%BD%D0%B8%D0%BA%D0%BD%D0%BE%D0%B2%D0%B5%D0%BD%D0%B8%D1%8F_%D0%B4%D0%B0%D0%BD%D0%BD%D0%BE%D0%B3%D0%BE_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F\"><\/span>Risk factors for the development of this disease<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Risk factors can be divided into two groups: those that provoke the underlying disease (portal hypertension) and those that accelerate the formation and progression of esophageal varices. The first group includes:<\/p>\n<ul>\n<li><strong>Chronic viral hepatitis B and C<\/strong> \u2014 the main cause of cirrhosis in the world; in Russia, hepatitis C remains the leader (up to 45% of cirrhosis cases);<\/li>\n<li><strong>Alcohol addiction<\/strong> \u2014 daily consumption of more than 60 g of pure ethanol (\u2248 150 ml of vodka) for 10 years leads to cirrhosis in 10\u201320% of men;<\/li>\n<li><strong>Non-alcoholic fatty liver disease (NAFLD)<\/strong> \u2014 especially when combined with obesity and type 2 diabetes;<\/li>\n<li><strong>Autoimmune hepatitis and primary biliary cholangitis<\/strong> \u2014 rare but severe forms, rapidly progressing to cirrhosis.<\/li>\n<\/ul>\n<p>The second group includes factors that increase pressure in the portal vein or damage the vein wall:<\/p>\n<ul>\n<li><strong>Increased intra-abdominal pressure<\/strong> \u2014 in ascites, obesity, pregnancy, or chronic cough (for example, in bronchial asthma);<\/li>\n<li><strong>Sharp increase in blood pressure<\/strong> \u2014 hypertensive crisis can provoke a vein rupture;<\/li>\n<li><strong>Intake of NSAIDs (ibuprofen, diclofenac)<\/strong> \u2014 they reduce the protection of the esophageal mucosa and increase the risk of erosions;<\/li>\n<li><strong>Consumption of coarse, spicy, or hot food<\/strong> \u2014 mechanical damage to the vein wall;<\/li>\n<li><strong>Smoking<\/strong> \u2014 nicotine causes vasospasm and enhances the fibrous reaction in the liver.<\/li>\n<\/ul>\n<p>Special attention to combined factors. For example, a patient with cirrhosis who smokes and takes ibuprofen for headaches has a 5 times higher risk of bleeding than the same patient without these habits. That is why in our clinic we always conduct a \"risk analysis\" before prescribing any medication \u2014 even a harmless analgesic.<\/p><script data-noptimize=\"\" data-wpfc-render=\"false\">\nfpm_start( \"true\" );\n<\/script>\n\n<h2><span class=\"ez-toc-section\" id=\"%D0%94%D0%B8%D0%B0%D0%B3%D0%BD%D0%BE%D1%81%D1%82%D0%B8%D0%BA%D0%B0_%D0%B4%D0%B0%D0%BD%D0%BD%D0%BE%D0%B3%D0%BE_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F\"><\/span>Diagnosis of this disease<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Diagnosis begins not with instruments, but with history. If a patient has cirrhosis, ascites, an enlarged spleen, or \"spider veins\" on the skin \u2014 there are already grounds to suspect esophageal varices. But the key method \u2014 <strong>esophagogastroduodenoscopy (EGDS)<\/strong>. This is not just a \"stomach examination,\" but a detailed study assessing the size, location, and condition of the veins. The doctor uses the classification by Paquet (or the more modern one by the Japanese Research Society for Portal Hypertension), where varices are assessed by three parameters: diameter (small \u2014 up to 5 mm, medium \u2014 5\u201310 mm, large \u2014 &gt;10 mm), color (blue \u2014 less dangerous, red \u2014 high risk of bleeding) and the presence of \"red spots\" or \"spiders\" \u2014 signs of increased fragility.<br \/>\nLaboratory tests do not directly reveal varices, but help assess liver function and the degree of portal hypertension:<\/p>\n<ul>\n<li><strong>Platelets<\/strong> \u2014 in portal hypertension they are reduced (&lt; 100\u00d710\u2079\/l);<\/li>\n<li><strong>Albumin and PTI<\/strong> \u2014 reflect the synthetic function of the liver;<\/li>\n<li><strong>Ultrasound with Doppler<\/strong> \u2014 allows measuring the blood flow velocity in the portal vein and identifying collaterals;<\/li>\n<li><strong>CT or MRI of the abdominal cavity<\/strong> \u2014 if necessary, to assess the volume of veins and exclude tumor causes of portal hypertension.<\/li>\n<\/ul>\n<p>Differential diagnosis is important: not every bleeding from the upper gastrointestinal tract is varicose. It is necessary to distinguish from:<\/p>\n<ul>\n<li>Erosive gastritis or duodenal ulcer;<\/li>\n<li>Esophageal cancer (especially in the case of solitary nodular varices);<\/li>\n<li>Telangiectasias (small vascular stars) in Osler\u2013Weber\u2013Rendu syndrome;<\/li>\n<li>Rupture of the cardiac section during vomiting (Mallory\u2013Weiss syndrome).<\/li>\n<\/ul>\n<p>If EGD is unavailable (for example, in an emergency situation), the clinic is guided by: vomiting \"coffee grounds,\" melena, rapid drop in hemoglobin \u2014 all these are \"red flags\" for immediate transfer to a hospital.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"%D0%9B%D0%B5%D1%87%D0%B5%D0%BD%D0%B8%D0%B5\"><\/span>Treatment<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Treatment of esophageal varices is not the elimination of the veins themselves, but control over the cause (portal hypertension) and prevention of bleeding. The approach depends on the stage: preventive, emergency, or secondary (after bleeding).<br \/>\n<strong>Preventive treatment<\/strong> is applied to patients with large varices (diameter &gt;5 mm) or the presence of \"red spots.\" The main method \u2014 <strong>endoscopic ligation<\/strong>: through the gastroscope, the doctor places rubber bands at the base of the vein, compressing it. The procedure takes 10\u201315 minutes, without anesthesia (can be done under sedation), and is repeated every 2\u20134 weeks until the veins completely disappear. Effectiveness \u2014 85\u201391% within a year.<br \/>\nIf ligation is impossible (for example, with severe esophageal deformation), <strong>sclerotherapy<\/strong> is used \u2014 the introduction of a solution of ethyl alcohol or polidocanol into the vein, which causes the walls to stick together. The downside of the method is a higher risk of ulceration and rebleeding compared to ligation.<br \/>\n<strong>Emergency treatment of bleeding<\/strong> \u2014 this is the \"fight for time\". The algorithm is as follows:<\/p>\n<ol>\n<li>Stabilization: introduction of a catheter into the central vein, blood transfusion, correction of coagulopathy;<\/li>\n<li>Medication therapy: terlipressin (0.5\u20132 mg\/hour IV) or somatostatin (250 mcg bolus + 250 mcg\/hour) \u2014 they reduce pressure in the portal vein by 30\u201340 %;<\/li>\n<li>Endoscopic intervention within 12 hours: ligation or sclerotherapy (in case of active bleeding \u2014 more often ligation);<\/li>\n<li>If endoscopy is ineffective \u2014 temporary use of a Blakemore balloon tube (pressure on the veins through an inflatable balloon), but this is just a \"bridge\" to surgery.<\/li>\n<\/ol>\n<p><strong>Surgical treatment** is rarely used, but necessary in cases of recurrent bleeding or ineffectiveness of endoscopy. Options:<\/p>\n<ul>\n<li><strong>Shunt operation<\/strong> (for example, mesocaval shunt) \u2014 creates a bypass for blood, reducing pressure in the portal system;<\/li>\n<li><strong>Liver transplantation** \u2014 the only radical method if there is decompensated cirrhosis.<\/strong><\/li>\n<\/ul>\n<p>Important: treatment must be comprehensive. Even after successful ligation, patients are prescribed \u03b2-blockers (propranolol or carvedilol) to reduce pressure in the portal vein by 20 %. Studies show: the combination of ligation + \u03b2-blockers reduces the risk of recurrence to 8 % per year compared to 25 % with monotherapy.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"%D0%A1%D0%BF%D0%B8%D1%81%D0%BE%D0%BA_%D0%BB%D0%B5%D0%BA%D0%B0%D1%80%D1%81%D1%82%D0%B2_%D0%BF%D1%80%D0%B8%D0%BC%D0%B5%D0%BD%D1%8F%D0%B5%D0%BC%D1%8B%D1%85_%D0%B4%D0%BB%D1%8F_%D0%BB%D0%B5%D1%87%D0%B5%D0%BD%D0%B8%D1%8F_%D0%B4%D0%B0%D0%BD%D0%BD%D0%BE%D0%B3%D0%BE_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F\"><\/span>List of medications used to treat this disease<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Medications are used not for \"treating veins,\" but for reducing portal pressure and preventing bleeding. Here are the main groups:<\/p>\n<table border=\"1\" cellpadding=\"5\" cellspacing=\"0\">\n<tr>\n<td><strong>Group<\/strong><\/td>\n<td><strong>Medications<\/strong><\/td>\n<td><strong>Mechanism of action<\/strong><\/td>\n<td><strong>Features of use<\/strong><\/&gt;\n><\/p>\n<tr>\n<td>\u03b2-blockers<\/td>\n<td>Propranolol, Carvedilol<\/td>\n<td>They reduce cardiac output and the tone of the splenic artery \u2192 decrease in pressure in the portal vein<\/td>\n<td>The initial dose of propranolol is 20 mg twice a day; titration to a heart rate of 55\u201360 beats\/min. Carvedilol is more effective but more expensive.\n <\/td>\n<\/tr>\n<tr>\n<td>Vasopressin and its analogs<\/td>\n<td>Terlipressin, Vasopressin<\/td>\n<td>They constrict the splenic arteries and reduce blood flow in the portal system.<\/td>\n<td>Terlipressin is a drug used in Europe (with fewer side effects), administered intravenously by infusion. It is contraindicated in coronary artery disease.<\/td>\n<\/tr>\n<tr>\n<td>Somatostatin and its analogs<\/td>\n<td>Somatostatin, Octreotide<\/td>\n<td>Reduce the secretion of gastrointestinal hormones and vascular tone<\/td>\n<td>Octreotide - long-acting (2-4 hours), convenient for patient transport.<\/td>\n<\/tr>\n<tr>\n<td>Antacids and PPIs<\/td>\n<td>Omeprazole, Pantoprazole, Ranitidine<\/td>\n<td>Protect the mucosa from acid, reduce the risk of erosions in varicose veins<\/td>\n<td>Mandatory during endoscopic intervention - at least 7 days before and after.<\/td>\n<\/tr>\n<tr>\n<td>Sclerosing agents<\/td>\n<td>Polidocanol, Ethyl alcohol 96 %<\/td>\n<td>Cause fibrosis and obliteration of the vein<\/td>\n<td>Used only endoscopically, the dose is strictly regulated (usually 1\u20132 ml per nodule).<\/td>\n<\/tr>\n<\/td>\n<\/tr>\n<\/table>\n<p>Note: self-medication is unacceptable. For example, propranolol should not be prescribed for bronchial asthma or AV block. An ECG and a consultation with a cardiologist are mandatory before starting therapy. In our practice, we have seen cases where a patient bought \"carvedilol\" at the pharmacy on a neighbor's advice \u2014 and two days later ended up in intensive care with bradycardia.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"%D0%9C%D0%BE%D0%BD%D0%B8%D1%82%D0%BE%D1%80%D0%B8%D0%BD%D0%B3_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F\"><\/span>Disease monitoring<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>After the detection of esophageal varices, the patient moves to the \"high-risk\" group and requires regular monitoring. Standard schedule:<\/p>\n<ul>\n<li><strong>First control<\/strong> \u2014 within 1\u20132 weeks after ligation\/sclerotherapy (assessment of healing, exclusion of bleeding);<\/li>\n<li><strong>Repeat EGD<\/strong> \u2014 in 2\u20133 months, then \u2014 every 6\u201312 months if stable;<\/li>\n<li><strong>Laboratory monitoring<\/strong> \u2014 once every 3 months: complete blood count, biochemistry (albumin, ALT, AST, bilirubin), coagulogram;<\/li>\n<li><strong>Ultrasound with Doppler<\/strong> \u2014 once every 6 months to assess blood flow velocity in the portal vein and spleen size.<\/li>\n<\/ul>\n<p>The prognosis depends on the underlying disease. In compensated cirrhosis and with regular prevention, the 5-year survival rate reaches 70 %. But if there have already been episodes of bleeding, it drops to 40\u201350 %. Key complications:<\/p>\n<ul>\n<li><strong>Recurrent bleeding** \u2014 the most common and dangerous outcome;<\/strong><\/li>\n<li><strong>Portal hypertensive gastropathy** \u2014 dilation of the stomach veins, often associated with esophageal varices;<\/strong><\/li>\n<li><strong>Hepatorenal syndrome** \u2014 acute renal failure against the background of cirrhosis;<\/strong><\/li>\n<li><strong>Hepatocerebral encephalopathy** \u2014 altered consciousness due to the toxic effects of ammonia.<\/strong><\/li>\n<\/ul>\n<p>If the patient develops new symptoms \u2014 weakness, pallor, decreased blood pressure, vomiting \"coffee grounds\" \u2014 this is a signal for immediate medical attention. Do not wait for hemoglobin to drop to 70 g\/L \u2014 in this case, the chance of saving a life decreases sharply.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"%D0%92%D0%BE%D0%B7%D1%80%D0%B0%D1%81%D1%82%D0%BD%D1%8B%D0%B5_%D0%BE%D1%81%D0%BE%D0%B1%D0%B5%D0%BD%D0%BD%D0%BE%D1%81%D1%82%D0%B8_%D0%B7%D0%B0%D0%B1%D0%BE%D0%BB%D0%B5%D0%B2%D0%B0%D0%BD%D0%B8%D1%8F\"><\/span>Age-related features of the disease<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Esophageal varices are a disease of adults, but their manifestation strongly depends on age and the cause of the underlying process.<br \/>\nIn <\/strong><strong>young patients (under 40 years old)<\/strong> varices are more often associated with hereditary diseases (hemochromatosis, Wilson's disease), autoimmune hepatitis, or toxic damage (for example, from taking methotrexate or high doses of paracetamol). Here it is important: veins can dilate faster because the liver is still \"compensating,\" and portal pressure rises rapidly. Bleeding in young people is often more massive \u2014 their vessels are more elastic, and rupture occurs suddenly.<br \/>\nIn <strong>In patients aged 40\u201360 years, viral hepatitis and alcoholic cirrhosis prevail. At this age, varicose veins are more often detected against the background of already pronounced ascites and thrombocytopenia. Here it is important: they often ignore symptoms, considering them as \"fatigue\" or \"nerves,\" and come to the clinic already with melena.<br \/>\nIn <\/strong><strong>elderly (over 65 years)<\/strong> Varicose veins are often associated with coronary artery disease, hypertension, and COPD. This complicates treatment: \u03b2-blockers can exacerbate bronchospasm, and terlipressin can cause a heart attack. Additionally, the elderly have a higher risk of \"silent\" bleeding \u2014 without vomiting, but with a rapid drop in hemoglobin and confusion. Therefore, in this group, we recommend more frequent monitoring \u2014 EGD every 4\u20136 months.<br \/>\nAn interesting nuance: in menopausal women, the risk of varicose progression is higher due to decreased estrogen levels, which have a protective effect on the endothelial cells of blood vessels. Therefore, when planning hormone therapy for patients with cirrhosis, this factor should be taken into account.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"%D0%92%D0%BE%D0%BF%D1%80%D0%BE%D1%81%D1%8B_%D0%B8_%D0%BE%D1%82%D0%B2%D0%B5%D1%82%D1%8B\"><\/span>Questions and Answers<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><strong>Question 1: Can esophageal varices be treated without surgery?<\/strong><br \/>\nYes, in most cases \u2014 without surgery. Endoscopic ligation and drug therapy (\u03b2-blockers) allow for the condition to be controlled in 80\u201390% of patients. Complete \"cure\" is only possible with liver transplantation \u2014 but this is a last resort. The main thing is to prevent bleeding. If varices are detected at an early stage and all recommendations are followed (regular EGDs, taking medications, abstaining from alcohol), the patient can live 10 or more years without complications.<br \/>\n<strong>Question 2: Why is aspirin not allowed for esophageal varices?<\/strong><br \/>\nAspirin is acetylsalicylic acid, which suppresses platelet aggregation. In a patient with portal hypertension, the platelet level is already low (due to splenic \"sequestration\"), and adding aspirin sharply increases the risk of bleeding \u2014 not only from the esophagus but also from the stomach or intestines. Even one tablet can become a trigger. Instead of aspirin, paracetamol (at a dose of no more than 2 g\/day) is used for pain, but only after consulting a doctor.<br \/>\n<strong>Question 3: What foods are prohibited for esophageal varices?<\/strong><br \/>\nIt is not the foods themselves that are prohibited, but the ways they are consumed:<\/p>\n<ul>\n<li>Coarse fiber (raw carrots, cabbage, nuts) \u2014 can scratch the wall of the vein;<\/li>\n<li>Spicy, sour, very hot dishes \u2014 irritate the mucosa;<\/li>\n<li>Alcohol in any form \u2014 even beer increases pressure in the portal vein;<\/li>\n<li>Strong coffee and energy drinks \u2014 cause vasospasm and increase blood pressure.<\/li>\n<\/ul>\n<p>Fractional nutrition is recommended (5\u20136 times a day), soft food (purees, cereals, boiled meat), dish temperature \u2014 no higher than 40 \u00b0C.<br \/>\n<strong>Question 4: Can esophageal varices disappear on their own?<\/strong><br \/>\nNo. Veins do not \"narrow\" on their own. The only case is if the cause of portal hypertension is completely eliminated (for example, curing viral hepatitis C and achieving regression of fibrosis). But even then, the veins remain a \"memory\" \u2014 they can expand again upon relapse. Therefore, even after normalizing liver indicators, the patient must be monitored for at least 2 years.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"%D0%A2%D0%B8%D0%BF%D0%B8%D1%87%D0%BD%D1%8B%D0%B5_%D0%BE%D1%88%D0%B8%D0%B1%D0%BA%D0%B8_%D0%B8_%D0%BA%D0%B0%D0%BA_%D0%B8%D1%85_%D0%B8%D0%B7%D0%B1%D0%B5%D0%B6%D0%B0%D1%82%D1%8C\"><\/span>Typical mistakes and how to avoid them<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Mistake #1: \"I don't feel anything \u2014 so everything is fine.\"<br \/>\nEsophageal varices do not give symptoms until the moment of bleeding. Patients with cirrhosis should undergo esophagogastroduodenoscopy at least once a year \u2014 even if there are no complaints. Example: a 52-year-old man, drank \"on weekends,\" did not treat hepatitis C, refused esophagogastroduodenoscopy \"because he feels good.\" After 8 months \u2014 vomiting blood, resuscitation, death. This can be avoided: create a schedule for examinations and attach it to the refrigerator.<br \/>\nMistake #2: Self-administration of NSAIDs for joint pain.<br \/>\nIbuprofen, diclofenac, nimesulide \u2014 all of them irritate the mucosa and reduce coagulability. Instead, use paracetamol (if there is no liver failure) or local gels (for example, finalgon). Be sure to consult a gastroenterologist before taking any medication.<br \/>\nMistake #3: Refusal of \u03b2-blockers due to \"low blood pressure.\"<br \/>\nPatients often say: \"My blood pressure is 100\/60, why do I need propranolol?\". But here, systemic blood pressure is not important, but the pressure in the portal vein. \u03b2-blockers specifically lower it, and the dose is adjusted so that the heart rate does not drop below 55 beats per minute. If you feel weakness \u2014 do not stop the medication, but consult a doctor for dose adjustment.<br \/>\nMistake #4: Ignoring diet and eating regimen.<br \/>\nEven after successful ligation, the veins remain fragile. One serving of hot peppers or a piece of hard bread can lead to rupture. Keep a diary \u2014 write down everything you eat and note when you experienced discomfort or heartburn. This will help identify triggers.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"%D0%97%D0%B0%D0%BA%D0%BB%D1%8E%D1%87%D0%B5%D0%BD%D0%B8%D0%B5\"><\/span>Conclusion<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Esophageal varices are not a sentence, but a signal: your liver is working at its limit, and the body is looking for alternative pathways. The main thing is not to wait for bleeding, but to act in advance. If you have cirrhosis, ascites, or chronic hepatitis \u2014 get an upper gastrointestinal endoscopy today, not \"when you have time.\" Ligation is safe, effective, and available in most city hospitals. \u03b2-blockers are cheap, time-tested medications that save lives. And most importantly: you are not alone. In our clinic, we help over 200 patients with this diagnosis every month \u2014 and most of them live full lives, work, enjoy, and see their grandchildren. Remember: esophageal varices are not a disease, but a consequence. Treat the cause, control your blood pressure, take care of yourself \u2014 and you will be able to keep the situation under control for many years.<\/p>\n<div class=\"fpm_end\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Esophageal varices are not just a \"vein problem,\" but a serious complication that most often arises against the background of<\/p>","protected":false},"author":1,"featured_media":24309,"comment_status":"open","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[298],"tags":[],"class_list":["post-17316","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medlibrary"],"_links":{"self":[{"href":"https:\/\/valintermed.com\/en\/wp-json\/wp\/v2\/posts\/17316","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/valintermed.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/valintermed.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/valintermed.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/valintermed.com\/en\/wp-json\/wp\/v2\/comments?post=17316"}],"version-history":[{"count":5,"href":"https:\/\/valintermed.com\/en\/wp-json\/wp\/v2\/posts\/17316\/revisions"}],"predecessor-version":[{"id":17350,"href":"https:\/\/valintermed.com\/en\/wp-json\/wp\/v2\/posts\/17316\/revisions\/17350"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/valintermed.com\/en\/wp-json\/wp\/v2\/media\/24309"}],"wp:attachment":[{"href":"https:\/\/valintermed.com\/en\/wp-json\/wp\/v2\/media?parent=17316"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/valintermed.com\/en\/wp-json\/wp\/v2\/categories?post=17316"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/valintermed.com\/en\/wp-json\/wp\/v2\/tags?post=17316"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}