Nonselective Beta-Blocker Associated With Decreased Mortality in Patients With Gastric Varices

Gastric varices (GV) are a less common complication of portal hypertension than esophageal varices but are associated with higher mortality when hemorrhage occurs. While nonselective beta-blockers (NSBBs) have been extensively studied for the primary and secondary prevention of esophageal variceal hemorrhage, data on their efficacy in preventing gastric variceal hemorrhage remain limited. This study investigates the impact of NSBBs on clinical outcomes in patients with GV.

We conducted a retrospective cohort study of patients aged 18-75 years diagnosed with GV between January 1, 2015, and July 31, 2021, within an integrated healthcare system in Southern California. The cohort was followed until February 28, 2022. Outcomes, including gastric variceal hemorrhage, esophageal variceal hemorrhage, liver transplantation, transjugular intrahepatic portosystemic shunt placement, and mortality, were compared between NSBB users and nonusers using multivariate logistic regression analyses.

A total of 1276 patients with GV were identified, including 767 (62.5%) on NSBBs and 509 (41.5%) not receiving NSBBs. After a 7-year follow-up, mortality was lower in the NSBB group (39.2%) than in the non-NSBB group (50.9%) (OR = 0.62; 95% CI: 0.46-0.84). No significant differences were observed between groups for other clinical outcomes. The overall mortality rate at study completion was 40.1%.

In our study, NSBB use in patients with GV was associated with reduced mortality, suggesting a potential prognostic benefit in real-world clinical settings.