Histologic factors of the esophageal transection ring as clues to the pathogenesis of bleeding varices.

In the absence of other precipitating factors, such as Sengstaken intubation, there is little evidence for acute esophagitis being a major factor in precipitating hemorrhage from varices. Superficial blood filled channels are described lying within the epithelium. They appear to arise from papillae, extend close to the esophageal lumen and are lined by epithelial-like cells. It is proposed that rupture of these channels may initiate variceal bleeding and, being connected to the underlying larger vessels, give rise to substantial hemorrhage. It is also suggested that these superficial vascular channels may correspond to the cherry red spots seen on endoscopic examination.