The history of treatment of portal hypertension is characterized by a progressive tendency to treat patients in earlier stages of the disease. Indeed, in the beginning, treatment of portal hypertension was limited to treatment of acute bleeding and prevention of recurrent variceal bleeding; from the end of the 1980s it was shown that patients with high-risk varices but without previous bleeding are good candidates for a pharmacologic prophylaxis (and in some instances for an endoscopic prophylaxis). Recent research has been devoted to investigating whether prophylaxis of variceal bleeding should be started early, when varices are not yet present (in order to prevent varices formation), or when small varices with low risk of bleeding are seen, in order to decrease the risk of growth of varices and eventually the risk of variceal bleeding 1. This area of research, sometimes called “pre-primary prophylaxis”, is the background on which the clinical decisions on single patients with cirrhosis without varices or with small varices should be made.