EDITORIAL SYNOPSIS This paper confirms previous studies showing the increased risk of bleeding associated with blood group 0. There is an indication that this may also be true for acute perforation and indeed the relationship may be with the severity of the ulcer disease.In a previous paper (Horwich and Evans, 1966) a relationship was shown between the loss of gastric mucosal cells in 160 volunteer subjects and their ABO blood groups and ABH secretor status. Aspirin enhanced the loss from the gastric mucosa, and it was postulated that clinical overt bleeding from the gastric mucosa, whether aspirin-induced or not, may also be related to the ABO blood groups and secretor status. The present investigation concerns this problem, and it was also thought to be of value to extend the investigation to include subjects with duodenal ulcer because of the reported association with blood group 0 (Aird, Bentall, Mehigan, and Roberts, 1954) and with ABH non-secretion (Clarke, Edwards, Haddock, Howel-Evans, McConnell, and Sheppard, 1956). While the work was in progress, Langman and Doll (1965) reported an increased frequency of group 0 in gastric and duodenal ulcer subjects who had bled and an increased incidence of non-secretors in those who had undergone operation. METHODSTwo separate series of patients were ascertained. Case records were examined for a history of salicylate ingestion during the 48 hours before the onset of bleeding and recorded at the time of admission. Details were abstracted of a barium meal examination carried out within two weeks after the bleeding episode. Where the radiologist gave a firm opinion on the presence or absence of a gastric or duodenal lesion, this diagnosis was accepted for the purpose of this investigation. Persistent duodenal deformity was accepted as being due to scarringfrom ulceration. Gastric ulcers have been divided into two categories. The first category is the classical lesser curve gastric ulcer to the left of the angulus with no other radiological lesion in the stomach or duodenum, and corresponds to type I of Johnson, Rogers, and Wyatt (1964). The second category, which corresponds to types II and III of Johnson et al. (1964), contains all gastric ulcers which areaccompanied by any abnormality of the duodenum, and all gastric ulcers to the right of the angulus. The two categories have been separated in this way because types II and III of Johnson et al. (1964) both seem to possess such features of duodenal ulcer as hypersecretion and association with blood group 0.Cases were included in this series if the barium meal was normal or showed a duodenal or gastric ulcer. Cases were excluded if there was any suspicion of bleeding from other sites, such as epistaxis, haemoptysis, oesophageal varices, hiatus hernia, carcinoma, or lesions of the large bowel. In order to be comparable with the experimental gastric-cell-shedding series, cases were excluded if there had been a previous gastric operation, except suture of a simple perforation, and for the same reason subjects of blood g...

Gastric ulcers have a natural tendency towards healing, and a controlled therapeutic trial is the only reliable method for assessing the value of any method of treatment. This paper reports our experience with carbenoxolone, and confirms the studies of Doll et al. (1962 (1958) showed that stopping smoking helped to heal gastric ulcers.In the trial of carbenoxolone reported by Doll et al. (1962), of 30 patients receiving the drug 70% healed by two-thirds or more, while of 20 patients receiving dummy tablets 20% healed by two-thirds or more. The figure for complete healing in their trial was 37%.Revers (1946) undertook the first clinical trial of an extract of liquorice in the treatment of gastric ulceration. He demonstrated a beneficial effect, but a large number of patients developed oedema and interest waned. Liquorice extracts contain glycyrrhizic acid ; from this may be prepared the triterpenoid glycyrrhetinic acid. The latter acid has a low solubility in body fluids, and a water-soluble derivative has been synthesized-that is, the disodium salt of glycyrrhetinic acid hydrogen succinate (carbenoxolone sodium). It differs from preparations containing liquorice extracts, where the action cannot be attributed to any one constituent. MethodAll in-patients and out-patients attending the medical clinics of the hospital in whom a gastric ulcer was demonstrated radiologically were admitted to the trial, provided there were no contraindications. A double-blind trial was adopted; the clinician and radiologist, as well as the patient, were unaware of the precise medication being administered for the first two weeks and sometimes four weeks of treatment.Forty sets of tablets were prepared, only 35 of which were used. Half of the tablets contained 50 mg. of carbenoxolone, together with starch B.P., lactose B.P., and peppermint oil. The remaining, or " dummy," tablets were identical in appearance. The sets of tablets were intermingled and each set was given a trial number. The key to the trial tablets was kept in a sealed envelope, which was not opened until the trial was completed. When patients were admitted to the trial they were given the trial tablets by the dispensary in numerical order. In this way a random allocation of patients to the active-tablet and dummy-tablet groups was obtained. * Carbenoxolone sodium is available under the branded name of Biogastrone and is abbreviated to carbenoxolone throughout this paper.

ABO BLOOD GROUPS IN RELATION TO DUODENAL ULCERSince Aird, Bentall, Mehigan, and Roberts (1954) convincingly demonstrated a high incidence of blood group 0 in duodenal ulcer subjects there have been a number of confirmatory studies carried out in different ethnic groups and populations (McConnell, 1966). Studies have also been undertaken to see if there is an especially strong association between blood group 0 and some particular category of duodenal ulcer patient. Brown, Melrose, and Wallace (1956) found that there was a marked association between blood group 0 and duodenal ulcer subjects requiring surgery, and also an association which fell short of statistical significance in subjects who had suffered perforation or bleeding compared with those in whom duodenal ulcer had been diagnosed by radiology alone. However, Langman and Doll (1965) did not find a high incidence of blood group O in subjects who came to operation in their series of 479 duodenal ulcers but found that the association of blood group 0 with bleeding was very significant. Horwich, Evans, McConnell, and Donohoe (1966) confirmed the association between blood group 0 and bleeding in duodenal ulcer subjects and demonstrated a high incidence of blood group 0 also in subjects who had sustained a serious gastro-duodenal bleed but did not have any radiologically demonstrable gastro-duodenal lesion.In the study of Horwich et al. (1966) 125 subjects with perforated duodenal ulcer were blood grouped and 72 (58-1 %) were found to be of blood group 0 compared with 50-6 % in 549 subjects with duodenal ulcer which had not perforated or bled. Langman, Doll, and Saracci (1967) Wort, and Green (1964)and Fodor and Urcan (1966). Studies designed to discover a relationshipbetween ABH secretion and clinical categories of duodenal ulcer have shown a tendency for non-secretors to come to operation more frequently than secretors (Langman and Doll, 1965) but this was not confirmed by Horwich et al. (1966). Bleeding duodenal ulcer subjects have a similar incidence of ABH secretors as uncomplicated duodenal ulcer subjects (Langman and Doll, 1965;Horwich et al., 1966). A small series of 125 perforated duodenal ulcers has been investigated for ABH secretion by Horwich et al. (1966) and 38 (304 %) were non-secretors. This is a rather lower frequency than that found in bleeding ulcers or those which had caused only pain or obstruction. THE PRESENT STUDYThe aims of the present communication are (1) to see if there is an association between blood group 0 and bleeding outside the gastrointestinal tract, viz., menorrhagia; (2) to expand our series of blood grouped and secretor-typed perforated duodenal ulcer subjects to see if this clinical category is associated with either blood group 0 ornon-secretion. METHODSMENORRHAGIA CASES These cases were ascertained by examining case records of women diagnosed as 319 on 10 May 2018 by guest. Protected by copyright.

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