New practice guidelines on risk stratification and management of portal hypertension: towards a personalized multidisciplinary approach

The American Association for the Study of Liver Diseases (AASLD) has recently released the practice guidance on portal hypertension (PH) and varices in cirrhosis, offering a comprehensive framework for management of PH in chronic liver disease (1). By emphasizing early intervention with non-selective beta-blockers (NSBBs), particularly carvedilol, the guidance aims to prevent disease decompensation, enhance survival rates, and improve patient quality of life. Although there are some minor pragmatic differences, the AASLD goals align with those of the Baveno VII Consensus (2) on the relevance and use of non-invasive tests in the field of PH. AASLD and Baveno VII both recognize the critical importance of stratifying the risk of decompensation in patients with compensated advanced chronic liver disease (cACLD) using non-invasive diagnostic methods. Clinically significant portal hypertension (CSPH) is identified as the main driver of decompensation risk. Although the hepatic venous pressure gradient (HVPG) measurement is the gold standard for diagnosing CSPH, its invasiveness limits widespread use (3). Therefore, both guidelines recommend utilizing liver stiffness measurement (LSM) via transient elastography (TE) in combination with platelet counts to diagnose CSPH.