Idiopathic Peptic Ulcer: a Separate Entity or Diagnostic Uncertainty?

Purpose of the review: Idiopathic peptic ulcer disease (IPUD) is an ulcer with no identifiable etiology. The major causes of peptic ulceration are Helicobacter pylori infection and ingestion of non-steroidal anti-inflammatory drugs. Is this a truly idiopathic disease or simply a misdiagnosis? Recent findings: The diagnosis of H. pylori infection can be missed if patients are taking antibiotics or proton pump inhibitors or when gastrointestinal bleeding occurs. A history of NSAID ingestion is often also overlooked. The proportion of IPUDs has increased over time. IPUDs occur more commonly in older patients and those with comorbidities. They run a more aggressive course, often presenting with bleeding and other ulcer complications and are more difficult to manage. Summary: IPUD is a distinct albeit a small group of ulcers. The diagnosis is made after careful exclusion of H. pylori infection, NSAID ingestion, and other obscure causes of peptic ulcers. [ABSTRACT FROM AUTHOR]