Background: Non-alcoholic fatty liver disease (NAFLD) presents a significant health burden globally, impacting around 25% of adults. Ranging from steatosis to potentially lethal conditions like non-alcoholic steatohepatitis (NASH), the disease progression includes risks of fibrosis, cirrhosis, and liver malignancies. Traditional diagnostic methods for complications like portal hypertension and esophageal varices, such as hepatic venous pressure gradient (HVPG) measurement and endoscopy, are costly, and pose risks. Objectives: This review assesses the efficacy of non-invasive techniques for diagnosing portal hypertension and variceal bleeding in NAFLD cirrhosis patients. It aims to identify dependable non-invasive diagnostic methods and compare them with invasive techniques like HVPG and esophagogastroduodenoscopy (EGD). Methods: A thorough literature search was conducted across various databases including PubMed, Cochrane Library, Google Scholar, and ScienceDirect. Studies were chosen based on predefined criteria, focusing on adult participants with confirmed NAFLD cirrhosis and evaluating non-invasive diagnostic techniques for portal hypertension and variceal bleeding. Results: This review analyzed 11 studies involving 2,707 patients. Liver stiffness measurement (LSM) via transient elastography displayed significant sensitivity (85%) and specificity (79%) for diagnosing clinically significant portal hypertension (CSPH) at a 20 kPa cutoff. For severe portal hypertension (SPH), LSM exhibited 81% sensitivity and 85% specificity at a 25 kPa threshold. Combining LSM with platelet count yielded high sensitivity (97-98%) for detecting esophageal varices (EV) and high-risk esophageal varices (HREV) but lower specificity (32-74%). Spleen stiffness measurement (SSM) demonstrated good diagnostic performance, with 89% sensitivity and 75% specificity for CSPH at a 40 kPa cutoff. Conclusions: Non-invasive tests, notably LSM and SSM, exhibit promising diagnostic accuracy in identifying portal hypertension and variceal bleeding in NAFLD patients, supporting their role in ruling out these conditions. Further research is required to address test performance variability, standardize protocols, and integrate novel biomarkers and imaging modalities for enhanced diagnostic precision and clinical use.