Helicobacter pylori-Negative Nonsteroidal Anti-Inflammatory Drug-Negative Ulcer

A vast majority of ulcers of the stomach and duodenum are due to H pylori infection or nonsteroidal anti-inflammatory drug (NSAID) usage. In patients with apparent H pylori negative NSAID negative ulcers, it is essential to ensure that the H pylori tests are not falsely negative and that the patient is not taking mucosal damaging drugs unknowingly. There are a variety of rare causes of true H pylori negative NSAID negative ulcers which need to be considered, including underlying cancer/lymphoma, Crohn's disease, rare infections and the Zollinger Ellison syndrome. Patients with idiopathic ulcers should be maintained on proton pump inhibitor therapy and may require higher doses than traditionally used in H pylori positive ulcers.