Landmark studies on clinically significant portal hypertension and decompensated cirrhosis

The presence of clinically significant portal hypertension and decompensated cirrhosis heralds a significant change in a patient’s trajectory, with an associated high morbidity and mortality. Our understanding and treatment of these conditions has evolved significantly in modern times. This review aims to highlight the most important studies that have influenced our understanding and management of these complex conditions. In this manuscript, we explore the milestone studies in defining decompensation and recompensation, risk stratification, the pathophysiology and treatment of portal hypertension, ascites management, spontaneous bacterial peritonitis, hepatic encephalopathy, renal dysfunction and the potential for disease regression. While the field of hepatology is at an exciting frontier, with novel therapeutics emerging, it is important to reflect on which pivotal studies have brought us to our current standard of care.