American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the most common cause of upper gastrointestinal bleeding?

1. Esophageal varices

2. Gastroesophageal reflux disease

3. Peptic ulcer disease

4. Gastritis

The correct answer is: Peptic ulcer disease

Peptic ulcer disease is recognized as the most common cause of upper gastrointestinal bleeding. This condition encompasses ulcers that form in the lining of the stomach or the first part of the small intestine (duodenum) due to several factors, including the use of nonsteroidal anti-inflammatory drugs (NSAIDs), infection with Helicobacter pylori, and excessive alcohol consumption. When ulcers erode into blood vessels, they can cause significant bleeding, leading to hematemesis (vomiting of blood) or melena (black, tarry stools). The prevalence of peptic ulcers in the general population contributes to its status as the leading cause of upper GI bleeding. In contrast, while other conditions like esophageal varices, gastroesophageal reflux disease (GERD), and gastritis can also lead to upper GI bleeding, they are less common as a primary cause. Esophageal varices, usually resulting from portal hypertension, are significant but less frequently the initiating cause compared to peptic ulcers. GERD typically causes symptoms like heartburn and does not usually lead to bleeding, and gastritis can cause bleeding but is often associated with less severe bleeding episodes compared to ulcer disease. Thus, understanding the mechanisms and prevalence of peptic ulcer disease highlights its distinction