Hunger pain: a poor indicator of peptic ulcer in a developing country

Endoscopy of the esophagus, stomach, and duodenum and stool examinations for ova and parasites were performed in 63 adult Peruvian patients with "hunger pain" (HP) and other dyspeptic symptoms. No lesion capable of provoking HP was found at endoscopy in 50 (78%) of the 63 patients. Only 7 (12%) of the patients had evidence of active or healed peptic ulcers. Another 6 patients (10%) had either gastric erosions or duodenitis. One (2%) of the patients was infected with hookworm, a parasite that produces epigastric pain mimicking HP. The 12% rate of peptic ulcer in Peruvian patients with HP contrasts strongly with accumulated experience in most developed countries, whose rates of peptic ulcer associated with HP range from 60 to 75%. As the frequency of peptic ulcer is so variable in patients with HP, we suggest that the simple term "hunger pain" be used instead of "peptic ulcer pain" or "ulcer dyspepsia" to refer to the complaint of such patients.