*Review* **Recent Advances in the Management of Acute Variceal Hemorrhage**

**Alberto Zanetto 1, Sarah Shalaby 1, Paolo Feltracco 2, Martina Gambato 1, Giacomo Germani 1, Francesco Paolo Russo 1, Patrizia Burra <sup>1</sup> and Marco Senzolo 1,\***


**Abstract:** Gastrointestinal bleeding is one of the most relevant causes of death in patients with cirrhosis and clinically significant portal hypertension, with gastroesophageal varices being the most frequent source of hemorrhage. Despite survival has improved thanks to the standardization on medical treatment aiming to decrease portal hypertension and prevent infections, mortality remains significant. In this review, our goal is to discuss the most recent advances in the management of *esophageal* variceal hemorrhage in cirrhosis with specific attention to the treatment algorithms involving the use of indirect measurement of portal pressure (HVPG) and transjugular intrahepatic portosystemic shunt (TIPS), which aim to further reduce mortality in high-risk patients after acute variceal hemorrhage and in the setting of secondary prophylaxis.

**Keywords:** cirrhosis; decompensation; bleeding; varices; survival; infection
