Non-Helicobacter pylori, Non-NSAID Peptic Ulcer Disease

Rew, Jong Sun

Abstract

Non-Helicobacter pylori, non-NSAID peptic ulcer disease, termed idiopathic peptic ulcer disease (IPUD), is being increasingly recognized. Current data suggest that the relative proportion of patients with IPUD among those with peptic ulcers has been increasing for the past decade in both the West and East, while the prevalence of H. pylori ulcers has decreased. Potential causative or risk factors of IPUD include cigarette smoking, genetic predisposition, psychological factors, infections other than H. pylori, non-NSAID drugs or toxins, systemic inflammatory disease, and local mucosal defects. Diagnosis is made after confident exclusion of H. pylori infection by at least two different standard tests and accurate exclusion of unrecognized or surreptitious NSAID use by careful history taking and serologic assay. IPUD is characterized by higher complication and recurrence rates than other forms of peptic ulcer disease and has become a main cause of refractory ulcer disease. Maintenance therapy using proton pump inhibitors may be required at higher doses and for longer durations than in H. pylori- or NSAID-associated peptic ulcer diseases. Well-designed nationwide epidemiologic studies are required to fully elucidate this emerging condition.