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Figure 1. A 67-year-old woman was evaluated for a one-week history of mild epigastric pain and black stools. On the day of admission she had two episodes of hematemesis. Physical examination revealed a pulse of 92 per minute, blood pressure of 120/67 mm Hg, and pallor with minimal epigastric tenderness. Hypochromic microcytic anemia was found, with a hematocrit of 25 percent. The patient was not taking aspirin or other nonsteroidal antiinflammatory drugs. She had quit smoking a few years earlier, after she was found to have ischemic heart disease.
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