Clinical features of a duodenal ulcer

• pain - epigastric; radiates to the back; often worse at night
• onset 2 to 3 hours after eating
• relieved by eating and drinking milk
• precipitating factors include missing a meal, anxiety or stress
• nocturnal pain is a feature of duodenal ulceration

The pain may occur in 4 to 6 month cycles and last for 1 to 2 months (1).

Patients may gain weight as a result of an increased intake of food and milk. These feature are contrasted with those of gastric ulcers where the patient may become 'afraid to eat' because of the pain and loses weight because of lowered calorific intake.

Haematemesis and melaena may complicate all types of peptic ulceration.

A succussion splash this may occur in patients with gastric outlet obstruction, e.g. gastric carcinoma, chronic duodenal ulcer (1).

Reference:

• Pounder, R. (1994). Peptic ulceration. Medicine International, 22:6, 225-30.