Editing Peptic ulcer disease (section)

== '''Clinical manifestations:''' ==

* Dyspepsia (epigastric     discomfort) (present in 80%)
** Usually mid-epigastric pain      which is quite well localised
** CLASSICALLY occurs 2-5 hours      post-prandially, when acid secretion is maximal, and no food is present
** Frequently relieved shortly      after food/antacid ingestion
** Constant pain suggests      deeper penetration of the ulcer - radiating to back implies posterior      penetration, possibly through to pancreas
** May have non-specific      food-provoked symptoms
*** Nausea/vomiting, early       satiety, belching, fatty food intolerance, reflux in 45%
* Asymptomatic
** About 70%
** More likely to be      asymptomatic in older patients, those on NSAIDs
* Can't differentiate between     gastric and duodenal ulcers clinically
* Symptoms related to     complications
** Bleeding
** Gastric outlet obstruction
** Perforation
* Alarm features (in dyspepsia)
** Unintentional weight loss
** Progressive dysphagia
** Odynophagia
** Unexplained iron deficiency      anaemia
** Persistent vomiting
** Palpable mass or      lymphadenopathy
** Family history of upper GI      cancer