Risk factors that are associated with a variceal bleed are multiple and varied; a portal pressure in excess of 12 mm Hg appears to be a major prerequisite. The prohibitive mortality associated with variceal bleeding is again stressed; however, only one third of the patients with varices actually bleed from them. The management of variceal bleeding is best considered according to an approach of prophylactic therapy, management of an acute variceal bleed, or the long-term elective management of varices that have previously bled. A multitude of opinions exist extolling a specific therapy; however, there is minimal evidence that an improved survival ensues as a result of any single therapy. Clearly, progress has been made but the ideal therapy has yet to be identified.
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