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Recurrent Massive Hemorrhage in Patients With Achlorhydria and Atrophic Gastritis

Sidney J. Winawer, MD; Jose Bejar, MD; Norman Zamcheck, MD
Arch Intern Med. 1967;120(3):327-329. doi:10.1001/archinte.1967.00300030069013.
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Hemorrhagic gastritis has been observed in association with many diseases and following ingestion of alcohol and aspirin.1,2 It was appreciated that erosive gastritis and bleeding could occur in the presence of achlorhydria. However, emphasis has been placed in recent years on the presence of acid as an essential factor in the pathogenesis of the bleeding.3 In this report, three patients are described with massive recurrent hemorrhagic gastritis, each of whom had severe atrophic gastritis and achlorhydria.

Report of Cases 

Case 1.  —A 73-year-old white man, a former brewery worker and chronic alcoholic was hospitalized repeatedly at the Boston City Hospital because of recurrent melena and anemia and hypotension. In addition, he had calcific aortic stenosis, cardiomegaly, atrial fibrillation and congestive heart failure, and cirrhosis of the liver. Several of the bleeding episodes were preceded by alcohol ingestion, while others were not, and two bouts of bleeding occurred during


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