An 86-year-old male with significant comorbidities (type II diabetes mellitus, essential hypertension, dyslipidemia, chronic kidney disease, dilated hypokinetic cardiomyopathy, mild cognitive impairment and atrial fibrillation on direct oral anticoagulation) underwent EGD in March 2024 for IDA requiring three RBC transfusions (Hb 7.5 g/dL) that revealed a 35 mm actively bleeding gastric lesion (Figure 4a), positive for gastric adenocarcinoma at histopathological biopsy. The gene discussed is GSTM1; the disease is chronic kidney disease.