PATHOGENESIS OF VARICES IN SCHISTOSOMAL PORTAL-HYPERTENSION

Patients with schistosomiasis and portal hypertension have significant ly lower levels of hydroxyproline in their saphenous veins and anterio r rectus sheaths than do individuals without schistosomal hepatic fibr osis. The stomach of patients with schistosomal portal hypertension de monstrates an increased number of lymphatics by lymphangiography. The disrupted lymph node architecture in these patients could be partially responsible for dilation, tortuosity, and retrograde lymph flow in th e gastric lymphatics. These histological and lymphangiographic finding s could be attributed to the effect of venous and lymphatic hypertensi on. A postmortem histological examination of the esophagus of patients with decompensated schistosomal portal hypertension revealed edema of the entire esophageal wall with lymphatic dilation and tortuosity. Ba sed upon these data, we suggest that the varices that develop in patie nts with schistosomal portal hypertension occur as a consequence of an increased portal venous pressure together with acquired lymphangectas ia as well as an intrinsic weakness of the walls of the portosystemic venous channels.