THE CLINICAL PRESENTATION OF PEPTIC-ULCER DISEASE

Background A prospective study was performed in order to assess the cl inical presentation of peptic ulcer. Methods: Consecutive patients und ergoing upper GI endoscopy (n=1527) received a questionnaire consistin g 23 questions related to the upper abdomen. Eleven questions were sco red on a linear scale and a symptom score was calculated. Patients wit h a gastric (GU) or duodenal (DU) ulcer were included. As a reference group, patients in whom endoscopy did not reveal abnormalities were in cluded. This group was subdivided depending on whether their history w as positive (PPU+) or negative (PPU-) for previous peptic ulcer. Resul ts: GU was diagnosed in 43 patients, DU in 60; PPU+ consisted of 94 pa tients and PPU- of 382 patients. Patients with GU were significantly o lder (P<0.0001). The symptom score was 14 (SD 8.6) in GU, 16,6 (SD 8.5 ) in DU, 19.5 (SD 9.8) in PPU+, and 16.7 (SD 9.6) in PPU-. PPU+ had si gnificantly higher symptom score than the other groups. If all ulcer p atients (amalgamation of DU, GU and PPU+) were compared with PPU-, a p rior history of peptic ulcer, pain waning after a meal, and smoking we re the only features linked to peptic ulcer. On the other hand, postpr andial pain, food intolerance, nausea, and alcohol use have a negative prediction. Conclusions: It can be concluded that the symptom score i n peptic ulcer disease is low (the maximum possible score was 55). It is not possible to distinguish peptic ulcer patients from other dyspep tics on basis of the clinical presentation.