Portal hypertensive bleeding encompasses a spectrum of conditions that include esophageal, gastric, and ectopic varices and portal hypertensive gastrointestinal enteropathy. Esophageal variceal hemorrhage occurs through a combination of increased portal pressure and local factors within the varix itself. Management of esophageal varices includes primary prophylaxis of variceal hemorrhage, treatment of actively bleeding varices, and prevention of variceal rebleeding (secondary prophylaxis). Primary prophylaxis is pharmacologic therapy with β-blockers or variceal band ligation if β-blocker therapy fails or the therapy is not tolerated by the patient. Active bleeding is best treated endoscopically. Either pharmacologic or endoscopic therapy is appropriate for secondary prophylaxis. Surgical shunts or transjugular intrahepatic portosystemic shunts (TIPS) are second-line therapy.
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