Clinical features of peptic ulcers

The most common clinical presentation is recurrent abdominal pain, which is localised to the epigastric region, is related to the intake of food and has an episodic pattern.

Pain is referred to the epigastrium and is often so sharply localised that the patient can indicate its site with two or three fingers (the 'pointing sign'). Pain occurs intermittently during the day, often when the stomach is empty, such that the patient identifies it as 'hunger pain' and achieves relief by eating. Night pain is common in duodenal ulceration and can disrupt sleep.

In general, ulcer pain is relieved by food, milk or antacids and by belching and vomiting. Relief by vomiting is more typical of gastric ulcer than of duodenal ulcer; some patients learn to induce vomiting to gain pain relief. Pain is episodic and may last for several weeks at a time. Between episodes the patient feels perfectly well. Other symptoms, especially during episodes of pain, include waterbrash, heartburn, loss of appetite and vomiting. Occasionally the only symptoms are anorexia and nausea, or a sense of undue repletion after meals. In some patients the ulcer is completely 'silent', presenting for the first time with anaemia from chronic undetected blood loss, as an abrupt haematemesis or as acute perforation; in other patients there is recurrent acute bleeding without ulcer pain between the attacks.

Although the prevalence of peptic ulcer is decreasing in many Western communities, it still affects approximately 10% of all adults at some time in their lives. The male to female ratio for duodenal ulcer varies from 5:1 to 2:1, whilst that for a gastric ulcer is 2:1 or less.

Typical risk factors for gastric ulcer disease include the following:

• Helicobacter pylori (HP) infection

• chronic usage of non-steroidal anti-inflammatory drugs (NSAIDs)

• familial history of gastric ulceration

cigarette smoking

• stress and personality type

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