[Pathogenesis of bleeding esophageal varices]

Pressure in oesophageal varices was measured endoscopically in 52 patients, in 16 of them central portal-vein pressure additionally by percutaneously introduced transhepatic portal-vein catheter. Only in the region of the cardia occlusion segment was the portal-vein pressure the same as that in the oesophageal varices. The larger the varices the higher the average variceal pressure. Depending on the time interval since a meal there were marked pressure variations during the day in portal-vein pressure. Intra-abdominal pressure rise (e.g. on coughing, choking or vomiting) induces a sudden and marked pressure rise in the portal vein as well as the oesophageal varices. The larger the varices the greater the danger of rupture when these pressure rises occur. Gastro-oesophageal reflux plays no role in the pathogenesis of bleeding from oesophageal varices.