A bleeding gastric ulcer caused by anisakiasis

A man in his 70s presented to the emergency unit for hematemesis. His recent blood test showed normal liver and renal function, and serum anti-Helicobacter pylori (H. pylori) IgG antibody was negative. He took neither steroids nor nonsteroidal anti-infl ammatory drugs (NSAIDs). Emergency endoscopy revealed a bleeding gastric ulcer in the greater curvature of the gastric body (Fig. 1A). Endoscopic hemostasis was performed using a combination of hemoclips and soft coagulation using hot biopsy forceps. Next day, second-look endoscopy revealed an Anisakis larva (Fig. 1B) on the edge of the ulcer. Th e larva was removed with biopsy forceps (Fig. 1C). He said that he ate pickled mackerel fi sh 5 days before hematemesis. Anisakiasis is a human parasitic disease caused by eating undercooked or raw fi sh such as cod, salmon, herring or mackerel infected with third-stage Anisakis larvae [1,2]. Endoscopic appearance includes erythema, erosions, ulcerations, and submucosal tumor-like mass [2]. However, the incidence of bleeding gastric ulcers is low at 0.5% [3]. As Japanese dishes become popular around the world, consumption of raw fi sh food, sushi or sashimi, is increasing. We should be aware that anisakiasis can be a cause of non-H. pylori and non-NSAID peptic ulcer and bleeding.