Expert Practical Recommendations for Portal Hypertension in Cirrhosis

The purpose of these expert practical recommendations is to provide an updated, clinically oriented overview of the screening, diagnosis, treatment, and surveillance of portal hypertension in cirrhosis. Building on recent advances in the understanding and management of portal hypertension, this review summarizes evidence-based strategies for the identification and management of clinically significant portal hypertension in patients with advanced chronic liver disease, in line with the recent Baveno VIII consensus recommendations. It presents practical clinical pathways for risk stratification, the prevention of first and further decompensation, and the longitudinal follow-up focusing on promising non-invasive techniques, also in terms of diagnosing resolution of clinically significant portal hypertension. In addition, the review offers a comprehensive overview of the contemporary management of acute variceal bleeding, including initial resuscitation, pharmacological and endoscopic therapy, and the appropriate use of transjugular intrahepatic portosystemic shunts and other invasive strategies. In conclusion, these expert recommendations offer an updated and practical decision tool for the management of portal hypertension in cirrhosis by combining latest evidence with expert consensus to optimize patient care and improve clinical outcomes.