Clinical ideas for the prevention and treatment of early cirrhosis Consider first changing the patient’s lifestyle, such as quitting smoking and alcohol, and aggressive antiviral therapy. If cirrhosis persists, check the patient for the presence of esophagogastric fundic varices and perform primary screening for hepatocellular hepatocellular carcinoma. Further treatment may be with non-selective beta-blockers (for portal hypertension) and avoid NSAIDs, PPIs and aminoglycosides. If the patient has ascites, treatment is a low salt diet, diuretics, discontinuation of ACEI-like drugs, and liver transplantation may be considered. If there is hepatic encephalopathy, the primary treatment is to control and remove the causative factors and protect liver function from further damage, and patients with mild hepatic encephalopathy must be detected early. Prevention and treatment strategies for portal hypertension and esophagogastric fundic varices Decreased liver function and portal hypertension are the two main outcomes in the development of cirrhosis. Portal vein pressure depends on portal blood flow and portal vein resistance. Depending on the pressure difference between the hepatic vein and the inferior vena cava, i.e. the hepatic venous pressure gradient (HVPG), the appropriate treatment plan is decided: HVPG >10 mmHg, non-selective β-blockers can be applied to reduce HVPG by at least 20% within the maximum tolerable dose (controlling heart rate above 50 beats per minute and systolic blood pressure above 90 mmHg), or keeping HVPG at 12 mmHg or less; when HVPG R12 mmHg is highly susceptible to variceal vein rupture and bleeding, endoscopic skin ring ligation and non-selective β-blocker therapy are performed. Primary prevention of variceal bleeding in cirrhosis Which patients with cirrhosis should have primary prevention? Endoscopy is recommended for all patients with cirrhosis at the time of diagnosis. Primary prevention is recommended if grade I varices with positive red signs or grade II-III varices are diagnosed, regardless of liver function. The best option for primary prevention: non-selective beta-blockers (NSBB) and variceal ligation (VBL). Propranolol should be the first-line pharmacological treatment. Propranolol: 40 mg/dose twice daily. Taper to maximum tolerated dose, or heart rate of 50-55 beats/min, or dose up to 320 mg/day.