Abstract Esophageal varices are the result of portal hypertension. Bleeding from varices occurs as the result of nature's attempt to shunt the high portal pressure of the portal bed into the systemic veins. Acute bleeding may be controlled for a short period of time either by the Sengstaken tube or by direct transthoracic ligation of the involved veins. Definitive surgery consists of reducing portal pressure by diverting blood from the portal to the general venous system by a splenorenal or portacaval shunt. If a shunt procedure is impossible, esophagogastrectomy must be performed. Therapy directed toward improving liver function is of paramount importance.