Symptoms

The classic symptom is pain in the epigastric area present two to three hours after a meal. It is a burning, painful, gnawing or aching sensation, with fullness or bloating, even awakening the patient from sleep. It is relieved by intake of food or antacids. The severity of the pain varies, and recurrence is common with periods of remission. Any change in the pattern of the pain may herald complications — constant pain unrelieved by any agent may suggest perforation, or adherence to the pancreas behind. Many patients with DU have no symptoms. There is often poor correlation between symptoms and healing. Surprisingly, duodenal ulcers never turn malignant. Complications are similar to gastric ulcer.



Diagnosis

Pain in the epigastric region and a little to the right side and below it, if relieved by food or antacids, is in favour of DU. Double contrast barium and endoscopy are helpful in diagnosis. Small ulcers missed by barium can be picked up by endoscopy.