title: Time trends of the impact of Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs on peptic ulcer bleeding in Japanese patients.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  The main cause of PUB has clearly shifted from H. pylori infection to the use of NSAIDs over the last decade.
authors: Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, Japan.
authors: Tomohiro
authors: T
authors: Nagasue
authors: Shotaro
authors: S
authors: Nakamura
authors: Shuji
authors: S
authors: Kochi
authors: Koichi
authors: K
authors: Kurahara
authors: Hiroki
authors: H
authors: Yaita
authors: Keisuke
authors: K
authors: Kawasaki
authors: Tadahiko
authors: T
authors: Fuchigami
mesh_terms: D000367:Age Factors; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D044466:Asian People; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D016481:Helicobacter Infections / Q000150:complications* / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005343:Fibrinolytic Agents