The clinical presentation of peptic ulcer disease
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B F Werdmuller1, A B van der Putten, R J Loffeld
1Department of Internal Medicine, Ziekenhuis De Heel Zaandam, Netherlands.
Background:
A prospective study was performed in order to assess the clinical presentation of peptic ulcer.
Methods:
Consecutive patients undergoing upper GI endoscopy (n = 1527) received a questionnaire consisting 23 questions related to the upper abdomen. Eleven questions were scored on a linear scale and a symptom score was calculated. Patients with a gastric (GU) or duodenal (DU) ulcer were included. As a reference group, patients in whom endoscopy did not reveal abnormalities were included. This group was subdivided depending on whether their history was positive (PPU+) or negative (PPU- ) for previous peptic ulcer.
Results:
GU was diagnosed in 43 patients, DU in 60; PPU+ consisted of 94 patients and PPU- of 382 patients. Patients with GU were significantly older (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 significantly higher symptom score than the other groups. If all ulcer patients (amalgamation of DU, GU and PPU+) were compared with PPU-, a prior history of peptic ulcer, pain waning after a meal, and smoking were the only features linked to peptic ulcer. On the other hand, postprandial pain, food intolerance, nausea, and alcohol use have a negative prediction.
Conclusions:
It can be concluded that the symptom score in peptic ulcer disease is low (the maximum possible score was 55). It is not possible to distinguish peptic ulcer patients from other dyspeptics on basis of the clinical presentation.