Portal hypertension is often associated with cirrhosis, and since China has a high prevalence of hepatitis B, it is easy to equate portal hypertension with cirrhosis. In fact, not all types of portal hypertension are caused by cirrhosis. One type of portal hypertension, regional portal hypertension, is not associated with cirrhosis. It occurs in less than 5% of portal hypertension and is the only type that is expected to be curable if it is not caused by a tumor. The number of cases of regional portal hypertension is relatively small. Patients with regional portal hypertension generally have varying degrees of upper gastrointestinal bleeding and no background of liver disease, normal liver function tests, no signs of cirrhosis on imaging, and gastroscopy suggestive of fundic esophageal varices, or isolated fundic varices, which are important manifestations of this condition and can be combined with clinical manifestations of hypersplenism. What is this all about? It turns out that the root cause of regional portal hypertension is obstruction of splenic venous flow, which can be broadly classified as pancreatic, splenic, or retroperitoneal in origin, depending on the anatomical location. Inflammation, tumor and other factors can cause compression and distortion of the splenic vein and lumen obstruction, resulting in increased venous pressure in the splenogastric region, leading to splenomegaly and collateral circulation, while at the same time the portal and superior mesenteric vein pressure remains normal. The collateral circulation includes: (1) most commonly through the short gastric vein and coronary vein into the portal vein, which is the basis for the formation of isolated fundic varices; (2) through the left gastroretinal vein into the left colonic vein, the inferior mesenteric vein into the portal vein, which can lead to varices at the splenic flexure of the colon; (3) from the left gastroretinal vein into the right gastroretinal vein and, rarely, into the retroperitoneal, renal or intercostal veins (4) If the coronary vein reflux to splenic vein or portal vein is obstructed, varices of fundic and esophageal veins may appear simultaneously. Therefore, patients with upper gastrointestinal bleeding who do not have a history of liver disease should not be taken lightly and should be alerted to the possibility of regional portal hypertension.