double-blind study of 40 patients with DU which found that 16 (40 percent)developed typical acid pain upon bathing the ulcer through the endoscope with0.1 N hydrochloric acid, while only 4 (10 percent) complained of pain with saline. In comparison, hydrochloric acid infusion into the duodenum did notproduce pain in patients without DU.However, the pain experienced by patients with peptic ulcers reflects factorsmore complex than acid bathing an ulcer crater. The secretory rates andconcentration of acid in symptomatic patients overlaps with that found inasymptomatic patients and in controls. In addition, there is often no correlationbetween the presence of an active ulcer (as shown by endoscopy) andsymptoms. As many as 40 percent of patients with healed ulcers (as shown byendoscopy) have persistent symptoms, while 15 to 44 percent of those whobecome symptom-free still have an ulcer crater at endoscopy [14,15].Thus, the disappearance of symptoms does not guarantee ulcer healing, nordoes the persistence of symptoms consistently predict the presence of an ulcercrater. For reasons that are not explicable, some patients perceive acid bathingtheir gastroduodenal mucosa, while others do not. In some cases thissensitization to acid is related to the presence of an ulcer crater or to thesecretion of excess acid, but it may occur in the face of grossly normal mucosaand with physiologic levels of acid secretion.
— The majority of complications, especially in the absenceof NSAID use, are associated with chronic peptic ulcers, which are surrounded byfibrosis and have been presumably smoldering for months or longer. NSAIDulcers sometimes lack surrounding fibrosis and are presumably acute,developing and complicating over the first days or weeks of NSAID use.Similarly, stress ulcers developing in the ICU setting can be acute, withoutsurrounding fibrosis. Complications may be heralded by new ulcer symptoms ora change in symptoms or may occur in the absence of typical symptoms ("silent"ulcers). (See"Complications of peptic ulcer disease".)
Penetrating ulcers classically present with a shift from the typical vaguevisceral discomfort to a more localized and intense pain that radiates to the backand is not relieved by food or antacids.
The sudden development of severe, diffuse abdominal pain may indicateperforation.
Vomiting is the cardinal feature present in most cases of pyloric outletobstruction.
Hemorrhage may be heralded by nausea, hematemesis, melena, or