Clinical features

The clinical presentation of peptic ulceration is variable. (1,2)

It may be asymptomatic, cause abdominal discomfort or abdominal pain. The most usual symptom is localized epigastric pain, described as burning or gnawing, for which the patient can characteristically point to the location of maximum intensity. The pain is associated with meals. Gastric ulcers give to rise to pain 15-20 minutes after meals, whereas duodenal ulceration causes pain 1-3 hours after a meal.

A succussion splash may occur in patients with gastric outlet obstruction due to pre-pyloric scarring or oedema.

National Institute for Health and Care Excellence (NICE) recommends urgent upper gastrointestinal endoscopy (within 2 weeks) for any person aged ≥55 years who has weight loss together with any one of dyspepsia, reflux, or upper abdominal pain. (3)

1. Moayyedi PM, Lacy BE, Andrews CN, et al. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017 Jul;112(7):988-1013.
2. Prabhu V, Shivani A. An overview of history, pathogenesis and treatment of perforated peptic ulcer disease with evaluation of prognostic scoring in adults. Ann Med Health Sci Res. 2014 Jan;4(1):22-9.
3. National Institute for Health and Care Excellence. Suspected cancer: recognition and referral. Oct 2023 [internet publication].