Gastric varices are a serious but less common complication of portal hypertension compared to esophageal varices, with significantly higher risks of severe bleeding and mortality.

Current therapeutic strategies remain limited by high rebleeding rates and procedure-related complications, and standardized guidelines are lacking.

A large retrospective cohort study from Kaiser Permanente Southern California (n=1,276; mean age 58 years; 63% male) evaluated the impact of nonselective beta-blockers (NSBBs) on outcomes in patients with gastric varices.

NSBB use was associated with a significant reduction in overall mortality (39.2% vs 50.9%; OR = 0.62; 95% CI = 0.46–0.84) but not with decreased rates of gastric variceal or esophageal variceal hemorrhage, TIPS placement, or liver transplantation.

Among individual NSBBs, nadolol showed the strongest survival association, followed by propranolol; carvedilol could not be assessed due to underrepresentation. Median survival after NSBB initiation was 1.4 years.

Source: Gastro Hep Advances