Causes of recurrent peptic ulcer disease

Persisting H. pylori infection

Poor compliance with treatment

Resistant organism

Inadequate H. pylori regimen

Unrecognized H. pylori infection:

False negative H. pylori testing

Skipped or inadequate testing

Ulcers related to nonsteroidal anti-inflammatory drugs (NSAIDs)

Continued NSAID use

Undiscovered NSAID use

Poor response to co-therapy with a proton pump inhibitor (PPI) or histamine 2 receptor antagonist (H2RA)

Other mechanisms

Hypersecretory states:

Gastrinoma

Antral G cell hyperfunction

Idiopathic hypersecretory duodenal ulcer

Co-therapies:

Glucocorticoids (especially when given with NSAIDs)

Cytotoxic drugs

Other drugs, such as methamphetamine or cocaine use

Uncommon causes:

Cancer

Crohn disease

Infections other than H. pylori

Eosinophilic, inflammatory, infiltrative conditions

H. pylori: Helicobacter pylori.

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