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General Practice 2023

Varicose veins in the stomach: what are they ão, causes and treatment

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Varicose veins in the stomach: what are they ão, causes and treatment
Varicose veins in the stomach: what are they ão, causes and treatment

Vericose veins in the stomach, also called gastric varices, are dilated and tortuous blood vessels that form in the wall of this organ, and can be serious, because as they become larger, they are at risk of rupturing and causing serious bleeding.

These varicose veins can form in the stomach due to increased resistance to 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. Understand better what it is and what can cause portal hypertension.

Generally, gastric varices arise after or in conjunction with varices in the esophagus, as well as the rectum.Treatment for these varicose veins is indicated both to prevent and to stop bleeding, and can be done with beta-blocker drugs or surgical procedures, such as sclerotherapy, cyanoacrylate or elastic bands, for example.

How to identify

Gastric varices may not cause any symptoms and are only identified in exams when portal hypertension is suspected, due to cirrhosis of the liver, for example. However, when these varicose veins rupture, which is rare, some symptoms can be noticed, the main ones being:

  • Blackish, foul-smelling stool;
  • Bloody vomiting;
  • Pale;
  • Dizziness;
  • Palpitations.

Thus, in the presence of signs and symptoms possibly indicative of rupture of varicose veins in the stomach, it is important that the general practitioner or gastroenterologist is consulted so that tests are carried out to identify the type of varicose vein and its severity.

Classification of types

The main tests to diagnose varicose veins are digestive endoscopy, Doppler ultrasound and tomography. They can be in different locations in the stomach, being classified as:

Classification of gastric varices

Classification of gastric varices

  1. They are a continuation of esophageal varices, extending a few centimeters below the esophagogastric junction, through the small curvature of the stomach, being the most common;
  2. They are also an extension of the esophageal varices, but towards the gastric fundus;
  3. They are isolated gastric varices, located in the bottom of the stomach;
  4. They are also isolated gastric varices, which can appear anywhere else in the stomach.

Gastric varices are considered small when they measure less than 3 mm in diameter, medium when they measure between 3 and 5 mm or large when they measure more than 5 mm in diameter. The larger the size of the varicose veins, the greater the risk of bleeding.

Causes of gastric varices

Varicose veins in the stomach are formed by increased pressure in the Portal vein, and the main reasons are:

  • Chronic hepatitis;
  • Liver cirrhosis;
  • Schistosomiasis;
  • Portal vein or splenic vein thrombosis;
  • Budd-Chiari Syndrome;
  • Portal vein or inferior vena cava malformations.

Varicose veins in the stomach can also be caused by a heart condition called constrictive pericarditis, in which fibrous tissue develops around the heart and makes it difficult to function.

How the treatment is done

If the varicose veins are small or if the doctor detects that there is a low risk of bleeding, there is no need for treatment of gastric varices, only regular monitoring.

However, the doctor may, in some cases, recommend treatment to prevent bleeding, especially if they measure more than 10 mm in diameter or there is a serious risk of bleeding, which can be done with beta-blocker drugs, which reduce the strength of blood flow, such as Propranolol, or the application of Cyanoacrylate, a kind of glue that eliminates the vessel.

On the other hand, when gastric varices present bleeding, treatment may include endoscopy for sclerotherapy, Cyanoacrylate injection or placement of elastic bandages, clips or springs, for example.

In addition to stopping the bleeding, as this is a serious situation, the doctor must take some precautions to protect the patient's life, such as replacing fluids with saline in the vein, giving blood transfusions, if necessary, or using antibiotics to prevent abdominal infections, common in patients with cirrhosis of the liver. Also check out other causes of stomach bleeding and what to do.

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