Non-nonsteroidal anti-inflammatory drug, nonmalignant gastric ulcers

The vast majority of gastric ulcers are owing to H. pylori infection or NSAID use. There are, however, uncommon causes of gastric ulceration that should be considered in the absence of these factors. Careful endoscopic evaluation of the ulcer associated with adequate biopsy specimens can provide the diagnosis in the vast majority of patients. All gastric ulcers should be evaluated by endoscopy and biopsy to rule out a possible malignancy. When adequate tissue samples are obtained the accuracy for diagnosis of gastric cancer is 99%. The prior recommendation of routine endoscopic follow up for gastric ulcers does not appear to be necessary. Repeat endoscopy should be reserved for patients whose initial endoscopic evaluation was inadequate or suspicious for malignancy, and those with refractory ulcers.