Background/Aims:Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) are the main causes of peptic ulcers. The purpose of the present study was to elucidate the time trends of the impact of H. pylori infection and use of NSAIDs and/or antithrombotic agents on peptic ulcer bleeding (PUB) in Japanese patients. Methods: We retrospectively reviewed 719 patients who had received endoscopic hemostasis for PUB between 2002 and 2013. Subjects were divided into either the first-half group (2002-2007, n = 363) or the second-half group (2008-2013, n = 356). The clinical characteristics of the patients, including the prevalence of H. pylori infection and use of NSAIDs and antithrombotic agents, were compared between the two groups. Results: Compared to the first-half group, patients in the second-half group were characterized by older age (proportion of the patients above 60 years old, 63.9 vs. 76.7%, p = 0.0002), less frequent H. pylori infection (71.6 vs. 57.9%, p < 0.001) and more frequent NSAID intake (39.9 vs. 48.6%, p = 0.02). No significant difference was observed regarding the use of antithrombotic agents between the two groups (18.6 vs. 23.3%, p = 0.13). The prevalence of H. pylori infection and proportion of patients above 60 years old were significantly different between the two groups in a multivariate analysis. Conclusion: The main cause of PUB has clearly shifted from H. pylori infection to the use of NSAIDs over the last decade.

Low prevalence of H. pylori infection, frequent duodenal location, and high rebleeding rate are characteristics of patients with bleeding gastroduodenal ulcer under antithrombotic medications. Continuation of antithrombotic medications can be accepted for bleeding gastroduodenal ulcer.

An 86-year-old man was admitted because of small-bowel wall thickening and mesenteric lymphadenopathy. Neither peripheral lymphadenopathy nor hepatosplenomegaly was noted. The leukocyte count was 7930/mm 3 , and no abnormal lymphocytes were found. The result of testing for serum antihuman T-lymphotropic virus type 1 (HTLV-1) antibody was positive. A bone marrow biopsy was normal without evidence of lymphoid infiltration. Smallbowel enteroclysis demonstrated a narrowing, edematous lesion with multiple ulcerations in the jejunum (• " Fig. 1). Capsule endoscopy (• " Fig. 2) and doubleballoon endoscopy (• " Fig. 3) showed enlarged Kerckring folds with annular and irregularly shaped shallow ulcers. Biopsy specimens from the ulcers revealed diffuse infiltration of medium to large pleomorphic lymphoid cells with CD3 +, CD4 +, CD5 +, CD25 +, CCR4 +, FoxP3 +, CD8-, CD20-, CD56-, and TIA1immunophenotype (• " Fig. 4). Biopsy specimens from the stomach, duodenum, ileum, and colon showed no lymphoma cells. Fluorodeoxyglucose F 18 positron emission tomography showed abnormal uptake in the jejunal mass, wide areas of mesentery, and Cases and Techniques Library (CTL) E613 Yaita Hiroki et al. Small-bowel adult T-cell leukemia/lymphoma with gastric AL amyloidosis … Endoscopy 2014; 46: E613-E614