Brzdęk M, Dobrowolska K, Janczura J, Wajdowicz M, Brzdęk K, Zarębska-Michaluk D, Gąsiorowska A, Mangia A. Advances in portal hypertension management: Evolution of the Baveno guidelines. World J Gastroenterol 2025; 31(35): 110241 [DOI: 10.3748/wjg.v31.i35.110241]
Corresponding Author of This Article
Dorota Zarębska-Michaluk, PhD, Professor, Department of Infectious Diseases and Allergology, Jan Kochanowski University, Radiowa 7, Kielce 25-516, Poland. dorota1010@tlen.pl
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Sep 21, 2025; 31(35): 110241 Published online Sep 21, 2025. doi: 10.3748/wjg.v31.i35.110241
Advances in portal hypertension management: Evolution of the Baveno guidelines
Michał Brzdęk, Krystyna Dobrowolska, Jakub Janczura, Małgorzata Wajdowicz, Kinga Brzdęk, Dorota Zarębska-Michaluk, Anita Gąsiorowska, Alessandra Mangia
Michał Brzdęk, Collegium Medicum, Jan Kochanowski University, Kielce 25-369, Poland
Michał Brzdęk, Anita Gąsiorowska, Department of Gastroenterology, Medical University of Lodz, Lodz 92-213, Poland
Krystyna Dobrowolska, Jakub Janczura, Kinga Brzdęk, Collegium Medicum, Jan Kochanowski University, Kielce 25-516, Poland
Małgorzata Wajdowicz, Clinical Department of Infectious Diseases with Hepatology Subdivision, Collegium Medicum University of Rzeszow, Rzeszow 35-959, Poland
Dorota Zarębska-Michaluk, Department of Infectious Diseases and Allergology, Jan Kochanowski University, Kielce 25-516, Poland
Alessandra Mangia, Liver Unit, Fondazione "Casa Sollievo della Sofferenza", IRCCS San Giovanni Rotondo, San Giovanni Rotondo 71013, Italy
Author contributions: Brzdęk M designed the manuscript, conducted the literature review, drafted the manuscript, prepared the tables, and prepared the manuscript for submission; Dobrowolska K designed the manuscript, conducted the literature review, and drafted the manuscript; Janczura J conducted the literature review and drafted the manuscript; Wajdowicz M conducted the literature review and drafted the manuscript; Brzdęk K drafted the manuscript, and prepared the tables and figures; Zarębska-Michaluk D edited and submitted the manuscript, and made critical revisions; Gąsiorowska A edited the manuscript, conducted the literature review, and made critical revisions; Mangia A designed the manuscript, edited the manuscript, and made critical revisions; All authors approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dorota Zarębska-Michaluk, PhD, Professor, Department of Infectious Diseases and Allergology, Jan Kochanowski University, Radiowa 7, Kielce 25-516, Poland. dorota1010@tlen.pl
Received: June 3, 2025 Revised: June 20, 2025 Accepted: August 13, 2025 Published online: September 21, 2025 Processing time: 108 Days and 13.8 Hours
Abstract
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.
Core Tip: This is the first and only comprehensive review to date covering all editions of the Baveno guidelines on portal hypertension. It traces the evolution of diagnostic and management strategies from invasive approaches to modern non-invasive tools, and outlines key shifts in surveillance, prophylaxis, and rescue therapy. The review summarizes resolved controversies, identifies current gaps in knowledge, and highlights future research directions that could further enhance clinical outcomes in portal hypertension.
