Advertisement

Drugs

, Volume 37, Supplement 2, pp 13–24 | Cite as

Morbidity and Mortality of Portal Hypertension

  • Joanna B. Ready
  • William G. Rector
Section 1

Summary

Portal hypertension occurs in several aetiologically distinct disease states associated with either increased flow or increased resistance in the portal venous system. The morbidity and mortality observed are the result of ascites formation, impaired hepatic metabolism, encephalopathy and, most ominously, variceal haemorrhage. Patients with conditions in which there is relatively little hepatic parenchymal damage (non-cirrhotic portal hypertension) tend to have fewer episodes of encephalopathy and are better able to tolerate bleeding episodes than those patients with underlying cirrhosis. Similarly, the development of ascites varies with respect to the aetiology of the portal hypertension. This chapter discusses the natural history of the various disease states that manifest portal hypertension, thus allowing critical evaluation of the various therapeutic modalities used in its treatment.

Keywords

Portal Hypertension Primary Biliary Cirrhosis Esophageal Varix Variceal Haemorrhage Chronic Active Hepatitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Andrade ZA, Andrade SG, Sadigursky M. Renal changes in patients with hepatosplenic schistosomiasis. American Journal of Tropical Medicine and Hygiene 20: 77–83, 1971PubMedGoogle Scholar
  2. Arico S, Aragona M, Rizzetto M, Zanetti A, Caredda F, et al. Clinical significance of antibody to the hepatitis delta virus in symptomless HBsAg carriers. Lancet 2: 356–358, 1985PubMedGoogle Scholar
  3. Baggenstoss AH, Stauffer MH. Posthepatic and alcoholic cirrhosis: clinicopathologic study of forty-three cases of each. Gastroenterology 22: 157–180, 1952PubMedGoogle Scholar
  4. Baggenstoss AH, Soloway RD, Summerskill WHJ, Elveback LR, Schoenfeld LJ. Chronic active liver disease. Human Pathology 3: 183–198, 1972PubMedGoogle Scholar
  5. Baker LA, Smith C, Lieberman G. The natural history of esophageal varices. American Journal of Medicine 26: 228–236, 1959PubMedGoogle Scholar
  6. Bassily S, Farid Z, Higashi GI, Kamel IA, El-Masry NA. Chronic hepatitis B antigenemia in patients with hepatosplenic schistosomiasis. Journal of Tropical Medicine and Hygiene 82: 248–251, 1979PubMedGoogle Scholar
  7. Berman M, Alter HJ, Ishak KG, Purcell RH, Jones EA. The chronic sequelae of non-A, non-B hepatitis. Annals of Internal Medicine 91: 1–6, 1979PubMedGoogle Scholar
  8. Beswick DR, Klatskin G, Boyer JL. Asymptomatic primary biliary cirrhosis. A progress report on long-term follow-up and natural history. Gastroenterology 89: 267–271, 1985Google Scholar
  9. Blendis LM, Lovell D, Barnes CG, Ritland S, Cattan D, et al. Oesophageal variceal bleeding in Felty’s syndrome associated with nodular regenerative hyperplasia. Annals of Rheumatic Diseases 37: 183–186, 1978Google Scholar
  10. Boyer JL, Sen Gupta KP, et al. Idiopathic portal hypertension. Comparison with the portal hypertension of cirrhosis and extrahepatic portal vein obstruction. Annals of Internal Medicine 66: 41–68, 1967Google Scholar
  11. Brown KM, Kaplan MM, Donowitz M. Extrahepatic portal venous thrombosis: frequent recognition of associated diseases. Journal of Clinical Gastroenterology 7: 153–159, 1985PubMedGoogle Scholar
  12. Burroughs AK, Jenkins WJ, Sherlock S, Dunk A, Walt RP, et al. Controlled trial of propranolol for the prevention of recurrent variceal hemorrhage in patients with cirrhosis. New England Journal of Medicine 309: 1539–1542, 1983PubMedGoogle Scholar
  13. Conn HO, Schreiber W, Elkington SG, Johnson TR. Cirrhosis and diabetes. American Journal of Digestive Diseases 14: 837–852, 1969PubMedGoogle Scholar
  14. Conn HO, Lindenmuth WW, May CJ, Ramsby GR. Prophylactic portacaval anastomosis. Medicine 51: 27–40, 1972PubMedGoogle Scholar
  15. Cook GC, Mulligan R, Sherlock S. Controlled prospective trial of corticosteroid therapy in active chronic hepatitis. Quarterly Journal of Medicine 158: 159–185, 1971Google Scholar
  16. Copenhagen Esophageal Varices Sclerotherapy Project. Sclerotherapy after first variceal hemorrhage in cirrhosis. New England Journal of Medicine 311: 1594–1600, 1984Google Scholar
  17. Dagradi AE. The natural history of esophageal varices in patients with alcoholic cirrhosis. American Journal of Gastroenterology 57: 520–540, 1971Google Scholar
  18. Datta DV, Mattocks AR, Khuroo MS, Aikat BK, Chhuttani PN. Herbal medicines and veno-occlusive disease in India. Postgraduate Medical Journal 54: 511–515, 1978PubMedGoogle Scholar
  19. DeCock KM, Awadh S, Raja RS, Wankya BM, Jupp RA, et al. Chronic splenomegaly in Nairobi, Kenya. II. Portal hypertension. Transactions of the Royal Society of Tropical Medicine 81: 107–110, 1987aGoogle Scholar
  20. DeCock KM, Hodgen AN, Lucas SB, Jupp RA, Slavin B, et al. Chronic splenomegaly in Nairobi, Kenya. I. Epidemiology, malarial antibody and immunoglobulin levels. Transactions of the Royal Society of Tropical Medicine and Hygiene 81: 100–106, 1987bGoogle Scholar
  21. Dienstag JL. Non-A, non-B hepatitis. I. Recognition, epidemiology, and clinical features. Gastroenterology 85: 439–462, 1983PubMedGoogle Scholar
  22. Dudley FJ, Scheuer PJ, Sherlock S. Natural history of hepatitis-associated antigen-positive chronic liver disease. Lancet 2: 1388–1393, 1972PubMedGoogle Scholar
  23. Dunn GD, Hayes P, Breen KJ, et al. The liver in congestive heart failure: a review. American Journal of Medicine 265: 174–189, 1973Google Scholar
  24. el-Zayadi A, el-Din SS, Kabil SM. Endoscopic sclerotherapy versus medical treatment for bleeding esophageal varices in patients with schistosomal liver disease. Gastrointestinal Endoscopy 34: 314–317, 1988PubMedGoogle Scholar
  25. Garceau AJ, Chambers TC, et al. The natural history of cirrhosis. I. Survival with esophageal varices. New England Journal of Medicine 268: 469–473, 1963PubMedGoogle Scholar
  26. Garceau AJ, Boston Inter-Hospital Liver Group. The natural history of cirrhosis. New England Journal of Medicine 271: 1173–1180, 1964PubMedGoogle Scholar
  27. Garcia-Tsao G, Groszmann RJ, Fischer RL, Conn HO, Atterbury CE, et al. Portal pressure, presence of gastroesophageal varices, and variceal bleeding. Hepatology 5: 419–424, 1985PubMedGoogle Scholar
  28. Gatta A, Merkel C, Sacerdoti D, Bolognesi M, Caregaro L, et al. Nadolol for prevention of variceal bleeding in cirrhosis: a controlled clinical trial. Digestion 37: 22–28, 1987PubMedGoogle Scholar
  29. Gibson JB, Johnston GW, Fulton TT, Rodgers HW. Extrahepatic portal venous obstruction. British Journal of Surgery 52: 129, 1965PubMedGoogle Scholar
  30. Gibson WR, Robertson HE. So-called biliary cirrhosis. Archives of Pathology 28: 37, 1939Google Scholar
  31. Gluud C, Henriksen JH, Nielsen G, Copenhagen study group for liver diseases. Prognostic indicators for alcoholic men. Hepatology 8: 222–227, 1988PubMedGoogle Scholar
  32. Glynn MJ. Isolated splenic vein thrombosis. Archives of Surgery 121: 723–725, 1986PubMedGoogle Scholar
  33. Gore DO, Stuart KL, Bras G. Veno-occlusive disease of the liver: surgical aspects. Surgery 49: 334–346, 1961PubMedGoogle Scholar
  34. Graham DY, Smith JL. The course of patients after variceal hemorrhage. Gastroenterology 80: 800–809, 1981PubMedGoogle Scholar
  35. Gregory P, Hartigan P, Amodeo D, Baum R, Camara D, et al. Prophylactic sclerotherapy for esophageal varices in alcoholic liver disease: results of a VA cooperative randomized trial. Gastroenterology 92: 1414, 1987Google Scholar
  36. Grunert RD, Oeff K, Gerstenberg E. Diagnosis of isolated splenic vein occlusion. Surgery 69: 364–367, 1966Google Scholar
  37. Hamilton DW, Hunt AH. Extrahepatic portal obstruction. Medical Journal of Australia 10: 493–499, 1970Google Scholar
  38. Hoefs JC, Peters RL, Redeker AG, Tong MJ, Mosley JW, et al. Chronic hepatitis B. Western Journal of Medicine 128: 305–317, 1978Google Scholar
  39. Iber FL. Obliterative portal venopathy of the liver and idiopathic portal hypertension. Annals of Internal Medicine 71: 660, 1969PubMedGoogle Scholar
  40. Idéo G, Bellati G, Fesce E, Grimoldi D. Nadolol can prevent the first gastrointestinal bleeding in cirrhotics: a prospective randomized study. Hepatology 8: 6–9, 1988PubMedGoogle Scholar
  41. Italian Multicenter Project for Propranolol in Prevention of Bleeding. Propranolol for prophylaxis of bleeding in cirrhotic patients with large varices: a multicenter, randomized clinical trial. Hepatology 8: 1–5, 1988Google Scholar
  42. Jackson FC, Perrin EB, Felix WR, Smith AG. A clinical investigation of the portacaval shunt: V. Survival analysis of the therapeutic operation. Annals of Surgery 174: 672–701, 1971Google Scholar
  43. Kanel GC, Govindarajan S, Peters RL. Chronic delta infection and liver biopsy changes in chronic active hepatitis B. Annals of Internal Medicine 101: 51–54, 1984PubMedGoogle Scholar
  44. Kew MC, Varma RR, Dos Santos HA, Scheuer PJ, Sherlock S. Portal hypertension in primary biliary cirrhosis. Gut 12: 830–834, 1971PubMedGoogle Scholar
  45. Kienast J, Vermylen J, Verstraete M. Venous thromboses in particular organs. Journal of the American College of Cardiology 8: 137B-145B, 1986Google Scholar
  46. Kirk AP, Jain S, Pocock S, Thomas HC, Sherlock S. Late results of the Royal Free Hospital prospective controlled trial of prednisolone therapy in hepatitis B surface antigen negative chronic active hepatitis. Gut 21: 78–83, 1980PubMedGoogle Scholar
  47. Koch H, Henning H, Grimm H, Soehendra N. Prophylactic sclerosing of esophageal varices — results of a prospective controlled study. Endoscopy 28: 40–43, 1986Google Scholar
  48. Koletsky S, Barnabee JH. “Cardiac” cirrhosis or congestive cirrhosis. American Journal of Medical Science 207: 421, 1944Google Scholar
  49. Koretz RL, Suffin SC, Gitnick GL. Post-transfusion chronic liver disease. Gastroenterology 71: 797, 1976PubMedGoogle Scholar
  50. Korula J, Balart LA, Radvan G, Zweiban BE, Larson AW, et al. A prospective randomized controlled trial of chronic esophageal variceal sclerotherapy. Hepatology 5: 584–589, 1985PubMedGoogle Scholar
  51. Kotin P, Hall EM. “Cardiac” cirrhosis or congestive cirrhosis of the liver. American Journal of Pathology 27: 561, 1951PubMedGoogle Scholar
  52. Kunkel HG, Aherns EH, Eisenmenger WJ, Bongiovanni AM, Slater RJ. Extreme hypergammaglobulinemia in young women with liver disease of unknown etiology (abstr.). Journal of Clinical Investigation 30: 654, 1951Google Scholar
  53. Lebrec D, deFleury P, Reuff B, Nahum H, Benhamou J-P. Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis. Gastroenterology 79: 1139–1144, 1980PubMedGoogle Scholar
  54. Lebrec D, Poynard T, Bernuau J, Bercoff E, Nouel O, et al. A randomized controlled study of propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: a final report. Hepatology 4: 355–358, 1984PubMedGoogle Scholar
  55. Long RG, Scheuer PJ, Path FRC, Sherlock S. Presentation and course of asymptomatic primary biliary cirrhosis. Gastroenterology 72: 1204–1207, 1977PubMedGoogle Scholar
  56. Lyford CL, Veraga GG, Moeller DD. Hepatic veno-occlusive disease originating in Equador. Gastroenterology 70: 105–108, 1976PubMedGoogle Scholar
  57. McDonald GB, Sharma P, Shulman H, Thomas ED. Veno-occlusive disease of the liver after marrow transplantation-clinical course of 53 patients. Gastroenterology 82: 1237, 1982Google Scholar
  58. Mikkelson WP. Extrahepatic portal hypertension in children. American Journal of Surgery 111: 333–340, 1966Google Scholar
  59. Mikkelson WP, Edmondson HA, Peters RL, Redeker AG, Reynolds TB. Extra- and intrahepatic portal hypertension without cirrhosis (hepatoportal sclerosis). Annals of Surgery 162: 602–620, 1965Google Scholar
  60. Mistilis SP, Skyring AP, Blackburn CRB. Natural history of active chronic hepatitis. I. Clinical features, course, diagnostic criteria, morbidity, mortality, and survival. Australian Annals of Medicine 17: 214–223, 1968Google Scholar
  61. Mitchell MC, Boitnott JK, Kaufman S, Camerson JL, Maddrey WC. Budd-Chiari syndrome: etiology, diagnosis and management. Medicine 61: 199–218, 1982PubMedGoogle Scholar
  62. Okuda K, Kono K, Ohnishi K, Kimura K, Omata M, et al. Clinical study of eighty-six cases of idiopathic portal hypertension and comparison with cirrhosis with splenomegaly. Gastroenterology 86: 600–610, 1984PubMedGoogle Scholar
  63. Orloff MJ, Johansen KH. Treatment of Budd-Chiari syndrome by side-to-side portacaval shunt: experimental and clinical results. Annals of Surgery 188: 494–512, 1978PubMedGoogle Scholar
  64. Paquet KJ. Prophylactic endoscopic sclerosing treatment of the esophageal variceal wall in varices — a prospective controlled randomized trial. Endoscopy 14: 4–5, 1982PubMedGoogle Scholar
  65. Parker RGF. Occlusion of the hepatic veins in man. Medicine 38: 369, 1959PubMedGoogle Scholar
  66. Pascal J, Calès P, and a multicenter study group. Propranolol in the prevention of first upper gastrointestinal tract hemorrhage in patients with cirrhosis of the liver and esophageal varices. New England Journal of Medicine 317: 856–861, 1987PubMedGoogle Scholar
  67. Pomier-Layrargues G, Villeneuve J, Willems B, Huet PM, Matlieau D. Systemic and hepatic hemodynamics after variceal hemorrhage: effects of propranolol and placebo. Gastroenterology 93: 1218–1224, 1987PubMedGoogle Scholar
  68. Powell WJ, Klatskin G. Duration of survival in patients with Laennec’s cirrhosis. American Journal of Medicine 44: 406–420, 1968PubMedGoogle Scholar
  69. Powell-Jackson PR, Melia W, Canalese J, Pickford RB, Portmann B, et al. Budd-Chiari syndrome: clinical patterns and therapy. Quarterly Journal of Medicine 201: 79–88, 1982Google Scholar
  70. Raia S, Mies S, Macedo AL. Portal hypertension in schistosomiasis. Clinical Gastroenterology 14: 57–82, 1985Google Scholar
  71. Ratnoff OD, Patek AJ. Natural history of Laennec’s cirrhosis of the liver: analysis of 386 cases. Medicine 21: 207, 1942Google Scholar
  72. Realdi G, Alberti A, Rigge M, Rigoli AM, Tremolada F. Long-term follow-up of acute and chronic non-A, non-B post-transfusion hepatitis: evidence of progression to liver cirrhosis. Gut 23: 270–275, 1982PubMedGoogle Scholar
  73. Rector WG. Portal hypertension: a permissive factor only in the development of ascites and variceal bleeding. Liver 6: 221–226, 1986PubMedGoogle Scholar
  74. Rector WG, Reynolds TB. Risk factors for haemorrhage from oesophageal varices and acute gastric erosions. Clinical Gastroenterology 14: 139–154, 1985Google Scholar
  75. Rector WG, Xu Y, Goldstein L, Peters RL, Reynolds TB. Membranous obstruction of the inferior vena cava in the United States. Medicine 64: 134–142, 1985PubMedGoogle Scholar
  76. Redeker AG. Viral hepatitis: clinical aspects. American Journal of Medical Science 270: 9, 1975Google Scholar
  77. Resnick RH, Chalmers TC, Ishihara AM, et al. A controlled study of the prophylactic portacaval shunt. Annals of Internal Medicine 70: 675–688, 1969PubMedGoogle Scholar
  78. Resnick RH, Iber FL, Ishihara AM, et al. A controlled study of the therapeutic portacaval shunt. Gastroenterology 67: 843–857, 1974PubMedGoogle Scholar
  79. Reynolds TB, Hidemura R, Michel H, Peters R. Portal hypertension without cirrhosis in alcoholic liver disease. Annals of Internal Medicine 70: 497–506, 1969PubMedGoogle Scholar
  80. Reynolds TB, Donovan AJ, Mikkelson WP, Redeker AG, Turrill AL, et al. Results of a 12-year randomized trial of portacaval shunt in patients with alcoholic liver disease and bleeding varices. Gastroenterology 80: 1005–1011, 1981PubMedGoogle Scholar
  81. Rizzetto M, Verme G, Recchia S, Bonino F, Farci P, et al. Chronic hepatitis in carriers of hepatitis B surface antigen, with intrahepatic expression of the delta antigen. Annals of Internal Medicine 98: 437–441, 1983PubMedGoogle Scholar
  82. Roll J, Boyer JL, Barry D, Klatskin G. The prognostic importance of clinical and histologic features in asymptomatic and symptomatic primary biliary cirrhosis. New England Journal of Medicine 308: 1–7, 1983PubMedGoogle Scholar
  83. Rougier P, Degott C, Rueff B, Benhamou J. Nodular regenerative hyperplasia of the liver. Gastroenterology 75: 169–172, 1978PubMedGoogle Scholar
  84. Rueff B, Degos F, Degos JD, Maillard JN, Prandi D, et al. A controlled study of therapeutic portacaval shunt in alcoholic cirrhosis. Lancet 1: 655–659, 1976PubMedGoogle Scholar
  85. Salih SY, Subaa HA, Asha HA, et al. Salmonellosis complicating schistosomiasis in the Sudan. Journal of Tropical Medicine and Hygiene 80: 14–18, 1977PubMedGoogle Scholar
  86. Sama SK, Bhargava S, Nath NG, Talwar JR, Nayak NC, et al. Noncirrhotic portal fibrosis. American Journal of Medicine 51: 160–169, 1971PubMedGoogle Scholar
  87. Santangelo WC, Dueno MI, Estes BL, Krejs GJ. Prophylactic sclerotherapy of large esophageal varices. New England Journal of Medicine 318: 814–818, 1988PubMedGoogle Scholar
  88. Sauerbruch T, Wotzka R, Köpcke W, Härlin M, Heldwein W, et al. Prophylactic sclerotherapy before the first episode of variceal hemorrhage in patients with cirrhosis. New England Journal of Medicine 319: 8–15, 1988PubMedGoogle Scholar
  89. Scobie BA, Summerskill WHJ. Hepatic cirrohosis secondary to obstruction of the biliary system. American Journal of Digestive Diseases 10: 135–146, 1965PubMedGoogle Scholar
  90. Selzer G, Parker RGF. Senecio poisoning exhibiting as Chiari’s syndrome. American Journal of Pathology 27: 885–900, 1951PubMedGoogle Scholar
  91. Sherlock S. Primary biliary cirrhosis (chronic intrahepatic obstructive jaundice). Gastroenterology 31: 574–585, 1959Google Scholar
  92. Sherlock S. Haematemesis in portal hypertension. British Journal of Surgery 51: 746–749, 1964PubMedGoogle Scholar
  93. Sherlock S, Feldman CA, Moran B, Scheuer PJ. Partial nodular transformation of the liver. American Journal of Medicine 40: 195–213, 1966PubMedGoogle Scholar
  94. Shulman HM, McDonald GB, Kopecky KJ, Gaubreau JM, Thomas ED. An analysis of hepatic venoocclusive disease and centrilobular hepatic degeneration following bone marrow transplantation. Gastroenterology 79: 1178–1191, 1980PubMedGoogle Scholar
  95. Sicot C, Benhamou J-P. Portal hypertension and primary biliary cirrhosis. Proceedings Fifth Meeting European Association for the Study of the Liver: 25–26, 1970Google Scholar
  96. Simson IW. Membranous obstruction of the inferior vena cava and hepatocellular carcinoma in South Africa. Gastroenterology 82: 171–178, 1982PubMedGoogle Scholar
  97. Soloway RD, Summerskill WH, Baggenstoss AH, et al. Clinical, biochemical and histological remissions of severe chronic active liver disease: a controlled study of treatments and early prognosis. Gastroenterology 63: 820–833, 1972PubMedGoogle Scholar
  98. Stone WE, Islam NRK, Paton A. The natural history of cirrhosis. Quarterly Journal of Medicine 145: 119–132, 1968Google Scholar
  99. Stromeyer FW, Ishak KG. Nodular transformation (nodular “regenerative” hyperplasia) of the liver. Human Pathology 12: 60–71, 1981PubMedGoogle Scholar
  100. Stuart KL, Bras G. Veno-occlusive disease of the liver. Quarterly Journal of Medicine 103: 291–315, 1957Google Scholar
  101. Sutton JP, Yarborough DY, Richards JT. Isolated splenic vein occlusion. Archives of Surgery 100: 623–626, 1970PubMedGoogle Scholar
  102. Tandon BN, Tandon HD, Tandon RK, Narndranathan M, et al. An epidemic of veno-occlusive disease of liver in central India. Lancet 2: 271–272, 1976PubMedGoogle Scholar
  103. Terblanche J, Bornman PC, Jonker MA, Campbell JAH, Wright J, et al. Failure of repeated injection sclerotherapy to improve long-term survival after oesophageal variceal bleeding. Lancet 2: 1328–1332, 1983PubMedGoogle Scholar
  104. Viallet A, Marleau D, Huet PM, Villeneuve J-P, Martin F, et al. Relationship between portal hypertension and bleeding from ruptured varices. Gastroenterology 79: 1129, 1980Google Scholar
  105. Villeneuve J-P, Huet PM, Joly JG, et al. Idiopathic portal hypertension. American Journal of Medicine 61: 459–464, 1976PubMedGoogle Scholar
  106. Villeneuve J-P, Pomier-Layrargues G, Infante-Rivard C, Willems B, Huet PM, et al. Propranolol for the prevention of recurrent variceal hemorrhage: a controlled trial. Hepatology 6: 1239–1243, 1986PubMedGoogle Scholar
  107. Vinel JP, Cassigneuil J, Voight JJ, Pascal J-P. Assessment of short-term prognosis after variceal bleeding in patients with alcoholic cirrhosis by early measurement of portohepatic gradient. Hepatology 6: 116–117, 1986PubMedGoogle Scholar
  108. Webb LJ, Sherlock S. The aetiology, presentation and natural history of extra-hepatic portal venous obstruction. Quarterly Journal of Medicine 192: 127–139, 1979Google Scholar
  109. Weissberg JI, Andres LL, Smith CI, Weick S, Nichols JE, et al. Survival in chronic hepatitis B. An analysis of 379 patients. Annals of Internal Medicine 101: 613–616, 1984Google Scholar
  110. Weller IVD, Karayiannis P, Lok ASF, Montano L, Bamber M, et al. Significance of delta agent infection in chronic hepatitis B virus infection: a study in British carriers. Gut 24: 1061–1063, 1983PubMedGoogle Scholar
  111. Westaby D, MacDougall BRD, Williams R. Improved survival following injection sclerotherapy for esophageal varices: final analysis of a controlled trial. Hepatology 5: 827–830, 1985PubMedGoogle Scholar
  112. Witzel L, Wolbergs E, Merki H. Prophylactic endoscopic sclerotherapy of oesophageal varices. Lancet 1: 773–775, 1985PubMedGoogle Scholar
  113. Yamamoto S, Yokayama Y, Takeshigi K, et al. Budd-Chiari syndrome with obstruction of the inferior vena cava. Gastroenterology 54: 1070, 1968PubMedGoogle Scholar
  114. Zeegen R, Stansfeld AG, Dawson AM, Hunt AH. Bleeding oesophageal varices as the presenting feature in primary biliary cirrhosis. Lancet 2: 9–12, 1969PubMedGoogle Scholar

Copyright information

© ADIS Press Limited 1989

Authors and Affiliations

  • Joanna B. Ready
    • 1
  • William G. Rector
    • 2
  1. 1.University of Colorado Health Sciences CenterUSA
  2. 2.University of Colorado Health Sciences CenterDenverUSA

Personalised recommendations