Systemic inflammatory markers in gastric ulcer: Leveraging routine blood tests

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Abstract
Gastric ulcer (GU) represents a clinically significant manifestation of peptic ulcer disease, driven by a complex interplay of microbial, environmental, and immune-inflammatory factors. A recent cross-sectional study by Shen et al systematically evaluated six complete blood count-derived inflammatory indices: Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation and demonstrated their positive associations with GU prevalence, identifying SIRI as the strongest predictor. This editorial contextualizes these findings within the broader literature, clarifies that these indices reflect systemic rather than GU-specific inflammation, highlights methodological strengths and major limitations, and proposes a conceptual clinical algorithm for integrating SIRI into GU risk assessment. Future multicenter studies incorporating Helicobacter pylori infection, non-steroidal anti-inflammatory drug exposure, and prospective design are essential to validate and translate these findings into clinical practice.

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