Gastrointestinal (GI) bleeding can occur for a multitude of reasons in a wide variety of patients. GI bleeding can vary from self-limiting, sub-clinical bleeding to catastrophic and even fatal hemorrhage. GI bleeding can essentially occur from the mouth to the anus, and, depending on the etiology, can be seen in the young, otherwise healthy patient, to the elderly and chronically ill patient. Thus, given the extensive list of etiologies of GI bleeding as well as the variety of locations from which it can occur, physicians are faced with not only diagnostic, but also therapeutic challenges in the management of patients with GI bleeding. Though historically gastrointestinal hemorrhage was managed primarily with surgical intervention, diagnostic advancements have been made that permit more accurate, targeted operations or supplant operations altogether, such as diagnostic and therapeutic endoscopy, visceral arteriography, and nuclear scintigraphy. The goals of therapy are similar, despite the etiology of the bleeding, including resuscitation and stabilization of the patient, preparation for ongoing blood loss and hemodynamic instability, and localization of the site of bleeding for appropriate therapeutic measures. The surgical management of variceal bleeding has followed a similar course in that surgical shunts are an effective, but much less frequently utilized form of therapy, often reserved for patients that fail pharmacologic, endoscopic, or minimally invasive interventional techniques, such as transjugular intrahepatic portosystemic shunts, or TIPS. The scope of the following chapter pertains to the non-surgical and surgical approach to GI bleeding in the patient with portal hypertension and/or cirrhosis.