Bleeding from esophageal varices is an emergency condition of the digestive system and one of the main causes of death in patients with liver cirrhosis. Bleeding occurs because of portal hypertension when there is resistance in the outflow of blood from the portal vein in the cirrhotic liver. The development of portosystemic collateral circulation occurs with the formation of esophageal varices in order to reduce the pressure in the portal vein and return the blood to the systemic circulation bypassing the cirrhotic liver. The increase in portal pressure eventually results in the rupture of the varices with a possible fatal outcome. Esophagogastroduodenoscopy represents the golden standard for the diagnosis of esophageal varices and variceal bleeding. According to the endoscopic indicators such as the shape, size and signs of bleeding varices, one can assess the risk of bleeding and choose the treatment method. Acute bleeding is an emergency that can result in hemorrhagic shock. Treatment of acute bleeding includes endoscopic therapy, vasoactive drugs, balloon tamponade, transjugular intrahepatic portosystemic shunt placement and surgical methods. For patients with cirrhosis and portal hypertension there is a possibility for primary and secondary prevention of variceal bleeding. With primary prevention, the goal is to prevent the first episode of bleeding, while secondary aims to prevent rebleeding. Primary prevention is based on monotherapy with either non-selective beta-blockers or carvedilol, or endoscopic variceal ligation, while secondary prevention uses a combination of non-selective beta-blockers and endoscopic variceal ligation. Treatment and prevention of bleeding from esophageal varices improves survival of patients with liver cirrhosis and portal hypertension, since esophageal bleeding represents a medical condition with high mortality rate.