Background Non-alcoholic fatty liver disease (NAFLD) is a significant global health concern, affecting around 25% of adults worldwide. From simple steatosis to non-alcoholic steatohepatitis (NASH), the progression can lead to severe complications like fibrosis, cirrhosis, and liver cancer. Current diagnostic methods such as hepatic venous pressure gradient (HVPG) measurement and endoscopy are expensive, inaccessible, and risky. Objectives This review evaluates non-invasive techniques for diagnosing portal hypertension and variceal bleeding in patients with NAFLD cirrhosis. The goal is to identify reliable non-invasive diagnostic strategies and compare them with invasive procedures like HVPG and esophagogastroduodenoscopy (EGD). Methods By conducting a thorough literature search on PubMed, Cochrane Library, Google Scholar, and ScienceDirect, relevant studies were selected based on specific criteria. These studies focused on non-invasive diagnostic methods for portal hypertension and variceal bleeding in adult participants with confirmed NAFLD cirrhosis. Results Among the 11 studies involving 2,707 patients, liver stiffness measurement (LSM) using transient elastography showed significant sensitivity (85%) and specificity (79%) in diagnosing clinically significant portal hypertension (CSPH). LSM, when combined with platelet count, exhibited high sensitivity (97-98%) in detecting esophageal varices (EV) and high-risk esophageal varices (HREV), albeit with lower specificity (32-74%). Spleen stiffness measurement (SSM) demonstrated good diagnostic performance, with a sensitivity of 89% and specificity of 75% for CSPH. Conclusion Non-invasive tests like LSM and SSM exhibit promising diagnostic accuracy for identifying portal hypertension and variceal bleeding in NAFLD patients. The high sensitivity of these tests, especially in combination, supports their role in clinically ruling out these conditions. LSM, particularly at higher thresholds, shows specificity in confirming diagnoses of CSPH, severe portal hypertension (SPH), and high-risk esophageal varices (HREV).