Pathophysiology of variceal bleeding in cirrhotics

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Annals of Gastroenterology
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Pathophysiology of variceal bleeding in cirrhotics (EN)

Escorsell A.,
Berzigotti A.,
Bosch J.,

SUMMARY Liver cirrhosis is frequently complicated by the development of portal hypertension. This syndrome is characterised by a pathological increase of the portal venous pressure, which leads to the formation of portal-systemic collaterals. Among these, gastroesophageal varices are of special interest, since are responsible for the main complication of portal hypertension, massive gastrointestinal bleeding. The development of collaterals is due to different factors, including the dilation of pre-existing vessels and the action of angiogenic factors. Once formed, varices tend to dilate as a function of time, persistence of portal hypertension, and repeated physiological stimuli such as meals, ethanol consumption, exercise, and increased intrabdominal pressure which cause abrupt rises in portal pressure and/ or blood flow. The concept ofvariceal wall tension, which combines variceal size, variceal wall thickness, and variceal pressure correlates well with the clinical observation that increased variceal pressure, increased variceal size and presence of red colour signs are independent predictors of the risk ofvariceal bleeding. Tension in the variceal wall is probably the decisive factor determining variceal bleeding, as when exceeding the elastic limit of the vessel, the varix ruptures. Endoscopie and endosonographic examinations may allow a better assessment ofvariceal pressure, size and wall thickness, and thus a more accurate evaluation of the individual risk ofvariceal bleeding in cirrhotic patients. Key Words: Liver Cirrhosis, Portal hypertension, Gastroeophageal varices, Variceal size, Variceal wall tension, Variceal bleeding. (EN)


Αγγλική γλώσσα


Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 14, No 3 (2001) (EN)

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