Gastric Bleeding Research Articles

Low Frequency of Upper Gastrointestinal Bleeding Despite Non-Steroidal Anti-Inflammatory Drugs and Corticosteroids in Patients with Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory disease. It has been identified that non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids can be essential risk factors for developing complications such as upper gastrointestinal bleeding (UGIB). This study aimed to describe the safety profile of drugs used to treat RA focused in UGIB. A cross-sectional study of patients with RA between 2015 and 2021, a description of the population, and an evaluation of the relationship with UGIB through bivariate analysis and logistic regression. Of 405 individuals, 16 presented UGIB (93.8% women, mean age was 65±13.6 years). No statistically significant differences were found regarding UGIB and medication use, except for the mean dose of corticosteroids. In the multivariate analysis, it was found that the presence of anemia in the last three months had an adjusted OR (AOR) of 16.1 (95% CI 2.74- 24.23) and higher HAQ values during the previous three months had an AOR of 6.17 (95% CI 1.79- 21.24). This study found a low frequency of UGIB in patients with RA. More significant disability and anemia in the previous months were independently associated with UGIB. The low frequency of NSAID use in this population is noteworthy. In general, reasonable medication use related to this complication is recommended.

Comparison and validation of several scoring systems for non-variceal upper gastrointestinal bleeding: a retrospective study.

Various scoring systems have been developed to predict outcomes in patients with non-variceal upper gastrointestinal bleeding (NVUGIB). However, their accuracy remains unclear. This study aimed to compare and validate the predictive performance of several established scoring systems in patients with NVUGIB: Glasgow-Blatchford score (GBS) and the age, blood tests, and comorbidities (ABC), mental status-anesthesiologist score-pulse-albumin-systolic blood pressure-hemoglobin (MAP(ASH)), Japanese, and Charlson comorbidity index-in-hospital onset-albumin-mental status-Eastern Cooperative Oncology Group performance status-steroids (CHAMPS) scores. We retrospectively reviewed the records of 1,241 patients who presented to the emergency department with NVUGIB and subsequently required hospitalization. Each scoring system was evaluated for its ability to predict in-hospital mortality, rebleeding, and the need for radiological or surgical intervention. The ABC score showed the highest accuracy in predicting in-hospital mortality. The MAP(ASH) score was the most effective predictor of rebleeding and the need for interventions. Different scoring systems have been optimized for various clinical outcomes. The ABC score was the best for predicting mortality, whereas the MAP(ASH) score excelled in identifying rebleeding risks and intervention needs. The selection of an appropriate scoring tool based on specific clinical scenarios can improve patient management and resource allocation in NVUGIB.

Regarding re-bleeding and all-cause mortality risk in non-variceal upper gastrointestinal bleeding: focusing on patients receiving oral anticoagulant therapy

Regarding re-bleeding and all-cause mortality risk in non-variceal upper gastrointestinal bleeding: focusing on patients receiving oral anticoagulant therapy

Over-the-Scope Clips vs Standard Endoscopic Interventions for First-line Treatment of NVUGI Bleeding: A Meta-analysis of Randomized Trials

Background and Aims: Recently, over-the-scope clips (OTSCs) have been extensively studied for hemostasis of nonvariceal upper gastrointestinal bleeding (NVUGIB). Our goal was to compare the efficacy of OTSCs with standard endoscopic interventions (SEIs) as first-line treatments. Methods: A comprehensive search of electronic databases was performed to identify Randomized Clinical Trials (RCTs) comparing OTSCs with SEIs as first-line therapy for NVUGIB. This search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results: Out of 819 reviewed studies, 5 RCTs comprising a total of 555 patients (277 OTSCs vs. 278 SEIs) were included. The OTSC group had a lower 30-day rebleeding rate (Risk Ratio [RR]: 0.43; 95% Confidence Interval [CI]: 0.24, 0.77; I²: 0%; p = 0.004) and a higher clinical success rate (RR: 1.19; 95% CI: 1.11, 1.28; I²: 0%; p < 0.00001). There was no significant difference in technical success (RR: 1.06; 95% CI: 0.98, 1.14; I² = 73%; p = 0.13), 30-day all-cause mortality (RR: 0.50; 95% CI: 0.22, 1.14; I²: 0%; p = 0.10), need for further intervention (RR: 1.22; 95% CI: 0.43, 3.47; I²: 0%; p = 0.71), or length of hospital stay (Mean Difference: 0.31; 95% CI: -1.08, 1.70; I²: 0%; p = 0.66). The risk of bias, which was assessed using the Cochrane Risk of Bias 2.0 tool, indicated some concerns of bias. Conclusion: OTSCs are more efficient than SEIs as a first-line treatment in terms of rebleeding within 30 days and clinical success rates.

The Management of Shunt Dysfunction Caused by Stent Deviation During Transjugular Intrahepatic Portosystemic Shunt (TIPS) Surgery for Esophageal and Gastric Varices Bleeding.

The Management of Shunt Dysfunction Caused by Stent Deviation During Transjugular Intrahepatic Portosystemic Shunt (TIPS) Surgery for Esophageal and Gastric Varices Bleeding.

Hepatosplenic schistosomiasis, treatment outcomes and associated factors among adult patients treated at public hospitals in the Harari Region of Ethiopia: retrospective cross-sectional study.

Schistosomiasis is one of the neglected tropical diseases that pose a significant burden in developing countries, particularly in sub-Saharan Africa. Hepatosplenic schistosomiasis (HSS) is a substantial cause of morbidity and mortality. This study aimed to determine clinical patterns, outcomes and factors associated with HSS in the Harari Region of Ethiopia. An institutional-based retrospective cross-sectional study was conducted among 93 adult patients diagnosed with HSS at public hospitals in the Harari Region from December 2018 to November 2022. Data were extracted from medical records using a standardized data extraction tool. EpiData version 4.2 and SPSS version 26.0 were used for data entry and analysis. Fisher's exact test was used to identify the association between dependent and independent variables, and statistical significance was declared at p<0.05. In the current study, HSS-related mortality was recorded in 7.5% of patients. Recurrent episodes of upper gastrointestinal (GI) bleeding (p=0.04), hypotension (p=0.02), altered mental status at admission (p=0.009) and antibiotic use for the treatment of spontaneous bacterial peritonitis (p=0.04) were significant factors associated with HSS-related mortality. The study found that treatment outcomes of HSS patients were strongly associated with recurrent upper GI bleeding, hypotension, altered mental status and antibiotic use for spontaneous bacterial peritonitis treatment. The use of antibiotics for spontaneous bacterial peritonitis treatment was strongly associated with the treatment outcome of patients with HSS and was unique to our study. Adequate recording of patient data, improving chart keeping, integration of preventive and curative programs, improvement of the diagnostic tools, comprehensive treatment guidelines, early diagnosis and treatment are strongly recommended. Rigorous prospective studies that can fully reflect cause-and-effect relationships are crucial to fill fundamental evidence gaps.

Clinical Outcomes of Patients with Bleeding Peptic Ulcer; Tertiary Center Experience

Background: Bleeding peptic ulcer remains an important cause of morbidity and mortality. Bleeding peptic ulcer (PUB) remains one of the most emergent and potentially fatal medical situations. However, the incidence of bleeding peptic ulcers not associated with H. pylori (Hp) infection or NSAID use varies considerably, and recent suggestions that patients with non-H. pylori–non-NSAID idiopathic bleeding peptic ulcers have a significantly higher mortality rate than patients with NSAID or H. pylori ulcers. Objective: The objective of this study was to demonstrate the epidemiological, clinical and endoscopic characteristics of peptic ulcer bleeding (PUB). Methods: This was a prospective study of patients who were admitted for peptic ulcers at Khulna Medical College Hospital Khulna, Bangladesh, from January 2021 to December 2021. Data were collected using a pretested and coded questionnaire and analyzed using SPSS computer software. Ethical approval to conduct the study was obtained from relevant authorities before the commencement of the study. Results: In this study, a total of 24 patients were included and analyzed. Regarding the age distribution of the study population, 11(45.83%) patients were &lt;65 years of age, 9(37.50%) patients were from the age group 65-80 years and 4(16.67%) patients were aged &gt;80 years. Also, 62.5 percent of patients were female and 37.5 percent were male. Among the study subjects, 14(58.33%) patients were treated by endoscopic therapy and 13(54.17%) patients had initial hemostasis. Initial hemostasis had some types also; 9(37.50%) patients had Epinephrine, 8(33.33%) patients had Epinephrine+endoclips, 5(20.83%) patients had endoclips. Conclusion: Three decades after the discovery of Hp, the etiologies of bleeding peptic ulcers are changing. However, diagnosis of Hp infection is still the priority in these patients. Invasive RUT is most frequently used, but this methodology is hampered by a high rate of false-negative results, especially in patients with UGI bleeding. Mediscope 2024;11(2): 77-81

Over-the-scope clips for Nonvariceal upper gastrointestinal bleeding: a systematic review and meta-analysis of randomized studies.

Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common and potentially life-threatening condition. Over-the-scope clips (OTSCs) have emerged as a promising endoscopic treatment option for NVUGIB. We aimed to analyze the efficacy and safety of OTSCs compared to standard endoscopic treatments (ST) in patients with NVUGIB. We conducted a comprehensive search of PubMed, Embase, Scopus, and Cochrane Library databases from inception to June 2024 for randomized controlled trials (RCTs) comparing OTSCs with ST for NVUGIB. The primary outcomes were initial hemostasis and persistent bleeding. Secondary outcomes included rebleeding rates, mortality, hospital stays and others. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random/fixed-effects models. Six RCTs involving 621 patients were included in the meta-analysis. OTSCs demonstrated significantly higher initial hemostasis (OR 4.80, 95% CI 1.78-12.96; P = 0.002) and lower persistent bleeding rates (OR 0.17, 95% CI 0.05-0.56; P = 0.003) compared to ST group. The rebleeding rate was significantly lower in the OTSC group 7-days re-bleeding (OR 0.27, 95% CI 0.14-0.53; P = 0.001); 30-days rebleeding (OR 0.40, 95%CI 0.22, 0.70; P = 0.002). No significant differences were observed in mortality (OR 0.65, 95% CI 0.31-1.33; P = 0.38) and hospital stay (mean difference 0.79days 95%CI -0.57, 2.15) between the two groups. OTSCs are more effective than ST for achieving hemostasis and preventing rebleeding in patients with NVUGIB, without increasing mortality. Key message What is Already Known Previous studies have shown that nonvariceal upper gastrointestinal bleeding (NVUGIB) is a serious medical condition that needs effective endoscopic interventions. The success rates of standard treatments for achieving hemostasis and preventing rebleeding are not consistent. What This Study Adds According to this study, over-the-scope clips (OTSCs) have the same mortality rate as standard endoscopic treatments, but they significantly improve initial hemostasis and lower rebleeding rates. Impact on Research, Practice, or Policy The findings support the use of OTSCs as a preferred intervention for NVUGIB, which could affect clinical guidelines and encourage additional research focused on improving endoscopic techniques and patient outcomes in the management of gastrointestinal bleeding.

Evaluating the Realism of a Task Trainer and the Impact on Residents’ Confidence in Managing Massive Upper Gastrointestinal Bleeding Among Emergency Medicine Residents

Evaluating the Realism of a Task Trainer and the Impact on Residents’ Confidence in Managing Massive Upper Gastrointestinal Bleeding Among Emergency Medicine Residents

Association Between Short-Term Exposure to Air Pollutants and Emergency Attendance for Upper Gastrointestinal Bleeding in Hong Kong: A Time-Series Study.

The relationship between exposure to ambient air pollutants and emergency attendance for upper gastrointestinal bleeding (UGIB) remains inconclusive. This study examines the association between short-term exposure to various ambient pollutants and the risk of UGIB emergency attendance. Data on daily UGIB emergency attendance, ambient pollutants, and meteorological conditions in Hong Kong were collected from 2017 to 2022. A time-series study using a distributed lag non-linear model to analyze the data, considering lag days. Stratified analysis was performed based on sex, seasons, and the COVID-19 pandemic period. The burden was quantified using attributable fraction (AF) and number (AN). The study included 31,577 UGIB emergency records. Exposure to high levels of PM2.5 significantly increased the risk of UGIB emergency attendance from lag day 3 (RR: 1.012) to day 6 (RR: 1.008). High NO2 exposure also posed a significant risk from lag day 0 (RR: 1.026) to day 2 (RR: 1.014), and from lag day 5 (RR: 1.013) to day 7 (RR: 1.024). However, there was no association between UGIB and high O3 levels. The attributable burden of high-concentration NO2 exposure was higher compared to those of PM2.5. Males and elderly individuals (≥65years) faced a higher risk of UGIB emergencies, particularly during cold seasons. Our study suggests that both PM2.5 and NO2 exposure are associated with an increased risk of emergency attendance for UGIB. Ambient pollutant exposure has a stronger effect on UGIB in males and the elderly, particularly during cold seasons.

Relationship between proton pump inhibitor and acute gout attacks in patients with acute upper gastrointestinal bleeding combined with gout

Relationship between proton pump inhibitor and acute gout attacks in patients with acute upper gastrointestinal bleeding combined with gout

013. Black Stools and Vomiting of Blood in Children Caused by Anemia Gravis ec Duodenal Ulcer Pars 2 with Perforation (Wound Healing with Branch A. Cystica Ruptur)

Background: Duodenal ulcers are rare in children but can lead to life-threatening complications such as perforation and severe anemia. Upper gastrointestinal bleeding, manifesting as hematemesis and melena, can result in anemia gravis, necessitating urgent intervention. The rupture of a cystic artery branch during the wound healing process adds further complexity to the condition. This case report aims to describe presentation, diagnosis, and management of a child with duodenal ulcer pars 2 complicated by perforation and anemia gravis, with attention to the role of a ruptured cystic artery branch in the wound healing process. Case: A 15-year-old boy presented with a 5-day history of vomiting blood and black stools. Initial evaluation included thorough physical examination, laboratory tests to assess anemia severity, and imaging studies to localize the source of bleeding. The patient underwent emergency surgery for perforated duodenal ulcer and associated hemorrhage. Intraoperative findings revealed rupture of a branch of the cystic artery. The patient was diagnosed with anemia gravis due to gastrointestinal bleeding secondary to a perforated duodenal ulcer. Surgical repair of the perforation and arterial rupture was performed. Postoperatively, the patient's hemoglobin levels improved following blood transfusion and supportive care. The patient recovered without complications. Conclusion: Early recognition of duodenal ulcers with perforation in children is crucial, especially in cases with severe anemia. Prompt surgical intervention and management of associated arterial complications, such as cystic artery rupture, are essential for favorable outcomes. This case underscores the importance of a multidisciplinary approach in managing complex pediatric gastrointestinal emergencies.

GLASGOW-BLATCHFORD AND ROCKALL SCORE UTILITY IN PREDICTING FINDINGS ON VIDEO CAPSULE ENDOSCOPY IN PATIENTS ADMITTED WITH OVERT SMALL BOWEL BLEEDING

Background and Aims Glasgow-Blachford (GBS) and Rockall scores are recognised tools to prioritize patients with upper gastrointestinal bleeding. Its utility in predicting findings on capsule endoscopy (CE) in patients with overt small bowel bleeding (OSBB) remains unclear. The aim was to assess the use of these scores in predicting relevant findings on CE and outcome among patients with suspected OSBB. Methods Retrospective analysis from January 2019 to June 2022. Clinical parameters and scores were collected at presentation and at 24 hours. Univariate analysis used simple logistic regression, chi-squared test or Mann-Whitney as needed. ROC analysis was performed selecting the optimal cut-off point maximized by the Youden index. Results 79 patients were included. 62% had relevant findings. The predictor showing the highest discrimination ability was the Initial GBS (AUC 0.625 95%CI 0.49 – 0.76). The optimal cut-off point was at least 4, with a sensitivity 98%, specificity 30% and accuracy 72%. Multivariable regression analysis showed inpatient status on CE (OR 117.27; CI 11.32 – 4492.93; p=0.001), shorter time to CE (OR 1.02; CI 1.01 – 1.04 p=0.018), higher initial GBS (OR 1.22; CI 1.06 – 1.43 p=0.009) and higher GBS within 24 hours (OR 1.19; CI 1.04 – 1.37 p= 0.013) were predictive factors for relevant findings on CE, with a model AUC 0.802, Sensitivity 91.8% and Specificity 63.3%. Conclusions GBS and Rockall score were useful in predicting relevant findings on CE in this cohort of patients with suspected OSBB. In patients with GBS 5 or higher, an early CE during the same admission, is warranted.

Adverse event profile of albumin-bound paclitaxel: a real-world pharmacovigilance analysis.

Abraxane plays a crucial role in the treatment of various types of cancer, despite the considerable attention it has garnered for its adverse drug events (ADEs). Nevertheless, there is currently a significant lack of comprehensive real-world pharmacovigilance studies on the ADEs associated with Abraxane. We conducted a retrospective analysis of ADEs associated with Abraxane using data mining from the FAERS database, analyzing data from 2005 to 2023. In a real-world setting, we quantified and visualized the signals of these ADEs using four pharmacovigilance algorithms. The FAERS database identified a total of 10,230 adverse event reports associated with Abraxane. The study revealed that Abraxane-related adverse drug events involved 27 system organ classes (SOC), with the strongest signals associated with the lymphatic and hematological systems and hepatobiliary disorders. Additionally, we identified 70 significant Preferred Terms (PT) signals, which included some critical adverse events not highlighted in the product labeling, such as cystoid macular edema. Further analysis of the timing of adverse reactions showed a median onset time of 41days. Most adverse events (AEs) occurred within the first month of using Abraxane (43.5%), although some were still possible 1year after treatment (3.5%). Gender-specific analysis indicated that high-risk AEs differed between females (nausea, vomiting, and erythema) and males (febrile neutropenia, disseminated intravascular coagulation, and upper gastrointestinal bleeding). The examined results provide crucial recommendations for optimizing the administration of Abraxane, enhancing its effectiveness, and mitigating potential adverse effects. This knowledge will substantially facilitate the implementation of the substance in clinical settings.

Predictive value of a noninvasive serological model for disease outcomes in patients with acute upper gastrointestinal bleeding

Predictive value of a noninvasive serological model for disease outcomes in patients with acute upper gastrointestinal bleeding

Clinical impact of performing esophagogastroduodenoscopy before percutaneous coronary intervention in patients with acute coronary syndrome patients and anaemia

Abstract Background In patients presenting with acute coronary syndrome (ACS) and anaemia, esophagogastroduodenoscopy (EGD) is commonly performed to exclude an upper gastrointestinal source of bleeding prior to perform percutaneous coronary intervention (PCI). However, the diagnostic yield and clinical impact of EGD in this setting is uncertain. Purpose We aimed to investigate the clinical yield and impacts of EGD on the 1-year clinical outcomes in ACS patients with concomitant anaemia who underwent PCI. Methods We retrospectively analysed electronic health records of ACS patients who underwent PCI at 16 public hospitals from 2014-2018. Patients with anaemia (defined as haemoglobin (Hb) &amp;lt;11dl/L) and EGD before PCI during the same admission were identified. The primary outcomes were bleeding events including clinical GIB (as diagnosed by EGD), need for urgent EGD, need for transfusion, Hb drop of &amp;gt;3 dl/L and Hb &amp;lt;8 dl/L. Secondary outcomes were 12-month 4-point MACE including myocardial infarction (MI), stroke, subsequent PCI or CABG, or cardiovascular-related death. Propensity-score models with inverse probability of treatment weighting (IPTW) against EGD were developed for the comparisons. A weighted Cox Proportional Hazard Model was performed to estimate adjusted hazards ratio (aHR) with corresponding 95% confidence intervals (CI). Results Of 13,793 patients, 3625 (25%) had anaemia on admission and 12.8% (n=466/3625) underwent EGD. Most EGD findings were not accountable for overt GIB, with gastritis, gastric polyps and gastric erosion being the 3 most common EGD diagnoses. After IPTW, clinical outcomes of 466 patients with EGD were compared with 3159 patients without EGD. 12-month bleeding event rates were higher among EGD patients compared to non-EGD patients (59.7% vs. 27.6%, p&amp;lt; 0.01; aHR = 3.01, 95% CI 2.58-3.52, p&amp;lt;0.005). Overall, 12-month GIB rate was low 1.0%, with 4.1% in EGD patients and 0.57% in non-EGD patients (aHR=7.99, 95% CI 4.13-15.45, p&amp;lt;0.005). The 12-month cumulative MACE rate overall was 39.9% and no significant difference between EGD and non-EGD patients. Conclusion Our real-world data demonstrated that the presence of anaemia is common among ACS patients. The yield of EGD in identifying sources of upper GI bleeding was low and there was no difference in 12-month clinical outcome among EGD patients. Although EGD was associated with higher rates of 12-month bleeding events, the cause was unclear with very low incidence of upper GI bleeding events. Therefore, the benefits of routine EGD prior to PCI in ACS patients with anaemic is unclear.

Hemostatic effect of oral hemocoagulase and Kangfuxin solution in patients with acute non-varicose upper gastrointestinal hemorrhage

Hemostatic effect of oral hemocoagulase and Kangfuxin solution in patients with acute non-varicose upper gastrointestinal hemorrhage

Exploring the Etiology and Clinical Diagnosis and Treatment of Upper Gastrointestinal Bleeding

Upper gastrointestinal bleeding refers to bleeding caused by the digestive tract above the flexor ligament, including diseases of the esophagus, stomach, duodenum, pancreas, biliary tract, and lesions after gastrojejunostomy. It is a common and critical condition in internal medicine. In recent years, with the continuous development of medical technology and the improvement of treatment methods, the diagnosis and treatment level of this disease has been greatly improved. However, this disease has the characteristics of fast onset, complex condition, and certain mortality rate. Therefore, exploring and analyzing the etiology, causes, and treatment plans of this disease is of great significance for improving the cure rate and prognosis of patients with this disease. Due to inflammation, mechanical injury, vascular disease, or adjacent organ lesions, the choice of treatment plan varies depending on the cause. Based on the above situation, this article, The etiology and diagnosis and treatment plan of upper gastrointestinal bleeding have been explored, which can provide reference for improving the treatment level of this disease

Acute Traumatic Coma Awakening Induced by Median Nerve Electrical Stimulation: A Systematic Review and Meta-Analysis.

Traumatic brain injury (TBI) is widely recognized as a major cause of death and disability. Optimizing recovery from coma is a priority for improving patient prognosis. Recently, an increasing number of studies have demonstrated that median nerve electrical stimulation (MNES) may be a potential approach for comatose patients awakening with TBI, although the results of these studies are not consistent. The aim of this study was to evaluate the effects of the MNES on recovery from coma in patients with TBI based on data from randomized controlled trials. The PubMed, Embase, Ovid MEDLINE, Cochrane Library, and China National Knowledge Infrastructure electronic databases were systematically searched from their inception to July 2023 using specific keywords. The χ2 test and I2 test were used to evaluate the heterogeneity across these studies. The mean differences with 95% confidence intervals (CIs) and relative risk (RR) with 95% CIs were adopted to analyze the continuous outcomes and binary outcomes, respectively. A total of 1831 patients from 18 studies were included in this meta-analysis. There were significant differences in the proportions of patients who regained consciousness between the MNES group and the control group after treatment (RR 1.36, 95% CI 1.18-1.56; P < 0.001) and at 6 months after injury (RR 1.31, 95% CI 1.16-1.47; P < 0.001). MNES significantly improved the Glasgow Coma Scale score (mean difference 2.38, 95% CI 1.78-2.98; P < 0.001). Furthermore, no significant differences in complications between the two groups of patients were observed, including pneumonitis (RR 0.86, 95% CI 0.72-1.03; P = 0.107), seizures (RR 1.24, 95% CI 0.49-3.10; P = 0.651), or gastric hemorrhage (RR 1.08, 95% CI 0.60-1.93; P = 0.795).The results of the present study indicate that patients with TBI in the MNES group recovered from coma more rapidly after treatment and at 6months after injury. These results suggest that MNES is an effective approach for coma awakening after TBI.

The effect of the type of constitution on the course of gastric ulcer in children

The purpose of the study. The study of the constitutional features of the course of gastric ulcer in children. Materials and methods. 102 children aged 12-17 years with a diagnosis of “gastric ulcer” were examined. A clinical and instrumental verification of the diagnosis, its complications, and an assessment of the type of constitution using the Pinier index was carried out using endoscopic examination. Results and conclusion. The dominance of children with gastric ulcer, having an asthenic type of constitution in comparison with normal and hypersthenics, has been established. Complications of gastric ulcer in the form of perforation of the stomach wall with the development of peritonitis, gastric bleeding were significantly more common in normosthenic patients, one and a half to two times less common in asthenics, never noted in hypersthenics, in whom concomitant reflux esophagitis was often detected.