Helicobacter pylori-negative peptic ulcer. What is its aetiopathogenesis and treatment?

Although the vast majority of peptic ulcers are widely considered as related to the germ Helicobacter pylori, ulcers exhibiting absence of this infection are increasingly seen in recent years. This fact has been partly related to a decreased prevalence of Helicobacter pylori among the population, a consequence of improved hygiene and housing conditions. Causes in relation to Helicobacter pylori-negative ulcers are: 1. Falsely negative infection diagnostic tests. They represent 25% of ulcers considered as Helicobacter pylori-negative in health-care practice (falsely negative diagnostic test 5%, previous or concomitant therapy with antibiotics, bismuth or proton pump inhibitors 20%). 2. Aspirin (ASA) or non-steroidal anti-inflammatory drug (NSAID) therapy. This is no doubt the most common cause, representing 50 to 60% of all infection-free ulcers. 3. Other causes (Zollinger-Ellison syndrome, Helicobacter heilmannii, generalised gut disease such as Crohn's disease, amyloidosis, eosinophilic gastroenteritis, etc.) may be responsible for less than 5% of all Helicobacter pylori-negative ulcers. 4. "Idiopathic" peptic ulcers. Thus are considered ulcers for which no potential cause may be found, representing 5-15% of all infection-free ulcers. Acid hyper-secretion is probably an important factor in them.