Portal hypertensive gastropathy (PHG) is a vascular disorder commonly seen in cirrhotic patients with portal hypertension. Although most cases of PHG have little clinical significance, this entity is being recognized more frequently as a source of overt and occult upper gastrointestinal bleeding. Unfortunately, it can be overlooked endoscopically in the patient who has blood within the gastric lumen or who has gastritis from nonsteroidal antiinflammatory drug use. In addition, PHG may not be considered in patients who are not known to be cirrhotics. Given these circumstances, PGH can be a source of recurrent, occult bleeding. This article reviews the unique endoscopic and histologic characteristics of PHG, the pathophysiologic factors leading to the development of PHG, its clinical manifestations, and its treatment.