Depending on how it is defined, between 3 and 20% of patients who have gastric biopsy specimens are diagnosed with "Helicobacter-negative gastritis." In a paper published in this issue of the Journal, data regarding use of tobacco, alcohol, nonsteroidal anti-inflammatory drugs, and proton pump inhibitors were collected from 41 patients with gastritis in whom no Helicobacters were detected by histology and culture and had negative serology. No significant associations with any of the parameters evaluated were found. Further studies are warranted to elucidate this elusive entity. Additional methods (e.g., the urea breath test and polymerase chain reaction) could be used to exclude Helicobacter infection, and a search for other candidate infectious agents (bacteria and Epstein-Barr virus) should be undertaken in those patients found to be unequivocally uninfected with Helicobacter.
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