Clinical features of Peptic ulcers Peptic ulcer disease is a chronic condition with spontaneous relapses and remissions lasting for decades, if not for life. The most common presentation is with recurrent abdominal pain that has three notable characteristics: localisation to the epigastrium, relationship to food and episodic occurrence. Occasional vomiting occurs in about 40% of ulcer subjects; persistent daily vomiting suggests gastric outlet obstruction. In one-third, the history is less characteristic, especially in elderly people or those taking NSAIDs. In this situation, pain may be absent or so slight that it is experienced only as a vague sense of epigastric unease. Occasionally, the only symptoms are anorexia and nausea, or early satiety after meals. In some patients, the ulcer is completely 'silent', presenting for the first time with anaemia from chronic undetected blood loss, as abrupt haematemesis or as acute perforation; in others, there is recurrent acute bleeding without ulcer pain. The diagnostic value of individual symptoms for peptic ulcer disease is poor; the history is therefore a poor predictor of the presence of an ulcer. Ref Davidson edition23rd pg 799