WHY PORTAL HYPERTENSIVE VARICES BLEED AND BLEED - A HYPOTHESIS

Continued bleeding or early rebleeding is associated with a poor progn osis in patients with variceal haemorrhage. It is not clear why bleedi ng stops in some patients and continues or restarts in others. It is s uggested that secondary haemodynamic changes in the splanchnic circula tion after a bleed may contribute to the risk of further bleeding. The se changes include the effects of hypotension on portocollateral resis tance, the effects of blood in the gut on splanchnic blood flow, and t he effects of blood volume expansion on portal venous pressure during resuscitation. These factors, working in concert, cause a secondary ri se in portal venous pressure, which may precipitate further bleeding. Treatment aimed at preventing these secondary haemodynamic changes may be beneficial. It is probable that somatostatin and octreotide could act in this way, which may explain their therapeutic efficacy.