What is the most common cause of gastrointestinal bleeding nowadays? Has the etiology of gastrointestinal bleeding changed over the past decades?
Janusz Jankowski: The answer to the first question is, it is still gastric ulceration and duodenal ulceration, peptic ulceration, if you will. The second commonest cause are gastric erosions, superficial ulcers, if you like. And the third cause are esophageal varices and gastric varices.
The frequency of these is changing slightly. Gastric and peptic ulcerations are becoming slightly less frequent simply because of the eradication of Helicobacter pylori. However, gastric erosions are increasing because of the amount of anticoagulation being used, low-dose aspirin, etc. However, the big risk that we have to consider in the future is the increase of esophageal and gastric varices because of the increase of alcoholic hepatitis and cirrhosis and, indeed, hepatitis C.