Helicobacter pylori-negative nonsteroidal anti-inflammatory drug-negative ulcer.

The most important clinical point for dyspeptic H pylori-negative NSAID-absent negative ulcers is to adequately ensure that these common risk factors are indeed absent. Once that is done, further investigations to include the rare causes of ulcer disease need to be performed and exclusion of underlying malignancy ensured. The possibility of the Zollinger Ellison syndrome should be considered, remembering that proton pump inhibitor therapy will mitigate its classical, clinical features.