Presentation

The chief presenting complaint of patients with peptic ulcer disease is abdominal pain. The pain is usually referred to the epigastrium or left upper quadrant and described as gnawing, burning, or stabbing. With duodenal ulcers, relief is frequently experienced with food intake. In contradistinction, patients with gastric ulcers will frequently have exacerbation of pain with food intake. Nausea and vomiting may be present but are not major features of this disease.

Duodenal ulcers are found in the first portion of the duodenum in about 95% of cases. The presence of ulcers in more distal areas of the duodenum is atypical and should arouse clinical suspicion of an underlying gastrinoma. Gastric ulcers most commonly occur on the lesser curvature. They are located just above the incisura angularis on the lesser curvature in about 60% of cases. An additional 15-25% are located distal to the incisura on the lesser curvature and another 10% are located high on the lesser curvature. Only about 5% are found on the greater curvature of the stomach.

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