Oesophageal and gastric varices represent one of the most serious complications of portal hypertension in patients with liver cirrhosis. They reflect advanced liver damage and are a leading cause of significant morbidity and mortality associated with acute variceal bleeding. Understanding the pathogenesis—encompassing elevated portal pressure, haemodynamic alterations and structural adaptations in the portosystemic circulation—is essential for optimal clinical management.
In recent years, substantial progress has been made in strategies for the early identification of patients at high risk of a first bleeding episode. Endoscopic screening remains the gold standard, but non-invasive methods such as transient elastography and serum-based indices have been introduced and validated, allowing postponement or avoidance of invasive procedures in selected patients. Primary prophylaxis is a cornerstone of contemporary cirrhosis management and includes pharmacological therapy with non-selective beta-blockers or endoscopic variceal ligation, with the choice depending on the individual risk profile and endoscopic findings.
This review presents current concepts in the pathogenesis, diagnostic approach and primary prophylaxis of oesophageal and gastric varices, with emphasis on personalised risk assessment and the integration of modern non-invasive methods into clinical practice.
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