This is an introduction to the Gut tutorial 'A case of bleeding oesophageal varices' hosted on BMJ Learning-the best available learning website for medical professionals from the BMJ Group. Acute variceal bleeding is a medical emergency and one of the main causes of mortality in patients with cirrhosis. Mortality has been decreasing in the past two decades. Portal hypertension leads to the formation of oesophageal varices, but the risk of bleeding is also influenced by the degree of liver dysfunction and the occurrence of other events such as bacterial infections. The management of variceal haemorrhage relies on non specific interventions such as adequate fluid resuscitation and airway protection, and on specific interventions. These are routine prophylactic antibiotics, vasoactive drugs and endoscopic treatment. In selected cases, procedures such as the placement of a Sengstaken-Blakemore tube or a transjugular intrahepatic portosystemic shunt (TIPS) can be lifesaving. Provided that TIPS is available, surgery is almost never required.
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