An estimated 170 million people worldwide have HCV infection as recorded by the World Health Organization (WHO) in 2011. Egypt has the highest countrywide prevalence of HCV in the world with an estimated 10 million patients. Upper gastrointestinal bleeding is among leading causes of death in patients with liver cirrhosis and portal hypertension. Asymmetric dimethylarginine (ADMA) is a naturally occurring amino acid that had been known to biochemists for decades. ADMA is an important regulator of vascular function. Many studies have documented increased ADMA levels in renal and hepatic failure; ADMA has been referred to as a new risk factor increased in liver cell failure. The present study was designed to evaluate the efficiency of ADMA as a simple non-invasive method easily available in clinical practice in prediction of high risk esophageal varices in cirrhotic patients as first line screening for OV with the aim of reducing the number of upper endoscopies needed to manage OV in patients with liver cirrhosis, and to detect the correlation between ADMA and OV grading. The study was conducted on 30 subjects, attending to internal medicine department at Kasr Al-Ainy hospital in the period from October 2009 to October 2010 and 10 normal control subjects. All studied subjects were submitted to clinical evaluation laboratory investigation, abdominal sonography and upper GIT endoscopy. This study concluded that in cirrhotic patient, upper GIT endoscopy is still the gold standard in esophageal varices diagnosis, but ADMA level in serum is a non-invasive parameter can predict the presence of the varices and can be used for the purpose of improving yield and cost-effectiveness when electively selecting patients for screening endoscopy and prophylactic therapy to decrease the incidence of first-time variceal bleeding. Decrease serum albumin, prothrombin concentration increased ADMA, AST, ALT and serum billirubin are predictors of portal hypertension and (presence and grading) of esophageal varices in cirrhotic liver due to virus C.