The following review article describes pathophysiological aspects of portal hypertension in its first part, especially the topographic variety of the vascular collateral system creating the danger of variceal bleeding. The second part discusses different forms of therapy including pharmaco- and sclerotherapy as well as operative and interventional procedures. Beta-blocker-therapy preferentially serves for the primary and secondary prevention of variceal bleeding. Sclerotherapy appears as the dominant therapeutic tool for the management of acute variceal bleeding. New chances of therapy include variceal banding and the implantation of a transjugular intrahepatic portosystemic stent-shunt (TIPSS). Operative procedure loose their significance more and more by the wide-spread use of sclerotherapy and the chance of a definite therapy of portal hypertension (liver transplantation) and the use of nonoperative interventional procedure (TIPSS or TIPS) which are still under clinical investigation.