Health Questions and Answers

Question: What may cause ulcers besides Helicobacter pylori?


Most H. pylori-negative gastric ulcers are associated with nonsteroidal anti-inflammatory drugs (NSAIDs). However, both adenocarcinoma and lymphoma can cause gastric ulceration and should be excluded. As the prevalence of H. pylori decreases, H. pylori-negative duodenal ulcers are more commonly encountered and now account for 40-60% of duodenal ulcers in the United States. They are often caused by NSAIDs, hypersecretory conditions, such as Zollinger-Ellison syndrome, or unusual manifestations of conditions, such as Crohn’s disease. True idiopathic duodenal ulcers may be genetically determined and are characterized by hypersecretion of acid, rapid gastric emptying, poor response to traditional treatment, frequent recurrence, and clinical complications.

Reference: Huang JQ, Sridhar S, Hunt RH: Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: A meta-analysis. Lancet 359:14-22, 2002.

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