Advances in portal hypertension management: Evolution of the Baveno guidelines

Management of portal hypertension has been the focus of the Baveno guidelines since 1990. This article explores the evolution of these recommendations and their impact on clinical practice. Initially reliant on invasive diagnostics such as the hepatic venous pressure gradient, later editions have incorporated non-invasive methods such as elastography and serum biomarkers. Management strategies have evolved substantially. Endoscopic surveillance has shifted from routine annual endoscopy to an individualized approach based on liver stiffness and platelet count. The role of non-selective beta-blockers (NSBBs) in primary prophylaxis has expanded. Endoscopic band ligation has become the preferred alternative for patients intolerant to NSBBs. In secondary prophylaxis, Baveno II replaced sclerotherapy with band ligation, and later guidelines confirmed the superiority of NSBBs combined with ligation. Transjugular intrahepatic portosystemic shunt emerged as the preferred rescue therapy, with early use emphasized in high-risk patients. Ongoing advancements continue to refine diagnostic and therapeutic strategies, further improving patient outcomes.