What causes Helicobacter pylori -negative non-NSAID-related ulcers?

Abstract

Although Helicobacter pylori infection is the single most common underlying cause of peptic ulceration, attention in the United States has recently focused on the apparently growing number of H. pylori-negative ulcers seen in clinical practice. Clearly, the epidemiology of H. pylori infection is changing; smaller family size and improvements in hygiene and sanitation mean less primary H. pylori infection in childhood. Incidence and prevalence rates of H. pylori infection are falling, at least in the developed world. The widespread eradication of H. pylori infection from adult patients with peptic ulcer disease and other conditions further reduces the opportunity for intra-familial transmission of the infection. Presumably, there has always been a subset of peptic ulcer disease that was unrelated to H. pylori infection. As the pool of H. pylori infection and H. pylori-related peptic ulcers has diminished, the proportion — although not, perhaps, the absolute number — of H. pylori-negative ulcers has risen.