**1. Introduction**

Gastrointestinal (GI) bleeding is the second most frequent decompensating event in cirrhosis [1], with gastroesophageal varices representing the most frequent source of bleeding. Despite significant advances in the management of this complication, development of acute variceal hemorrhage (VH) is still associated with a six-week mortality risk of ~15–20% [2]. In patients who recover from VH, the risk of rebleeding is influenced by the treatment of underlying portal hypertension, with ~60% of untreated patients that will experience recurrent bleeding within on to two years, in contrast with only ~30% of those receiving therapies that lower portal pressure [3].

In this review, we discuss the management of patients with cirrhosis presenting with *esophageal* VH, including both treatment of the acute event (first section) and strategies to prevent recurrent hemorrhage (second section). The management of *gastric* variceal hemorrhage requires specific consideration and has been recently reviewed in depth elsewhere [4], therefore, it will not be included in the present review.
