Controversies and certitudes on the upper digestive hemorrhage through rupture of esophageal varices. I. Pathophysiology of portal hypertension and mechanism of rupture of the esophageal varices.

The frequency and severity of the upper digestive hemorrhage in patients with liver cirrhosis situate it among the main complications of this disease. Many studies have tried to explain the pathogenesis of portal hypertension and the mechanism of rupture of the esophageal varices, emphasizing the role of the venous flow in the rise of portal pressure and that of the local venous factors in the variceal rupture. Based on the recent data in the medical literature and on its own experience, the author presents--in this first part of a review of these problems--the methods of diagnosis and of evaluation of the response to therapy in patients with portal hypertension and with bleeding through rupture of the esophageal varices.