For the first question, what is the symptoms of peptic ulcer ?

Symptoms
1. Up to 70% of patients are usually asymptomatic : which means the Signs and symptoms
of peptic ulcer disease may vary depending upon the location of the disease and age.
2. The typical symptoms or The characteristic features of peptic ulcer disease are abdominal
pain and abdominal discomfort
3. Characteristics of the abdominal pain are they are chronic (it has a recurrent nature and
last for long time (it can last for weeks, months, or even years) and are periodic (Because,
it followed by pain- free periods for weeks or months). 
4. The pain can be dull, stabbing, or burning, but we need pay attention that It’s not specific
5. It Is usually located in the epigastrium and does not radiate, However, these symptoms
are neither sensitive nor specific. The Pain radiating to the back may suggest that an ulcer
has penetrated posteriorly, or the pain may be pancreatic in origin. Pain radiating to the
right upper quadrant may suggest disease of the gallbladder or bile ducts.
6. Pain degree depends on severity of the damage of the ulcer. It can be mild, moderate, or
even severe. 
7. The Frequency of the pain can be paroxymal or persistent
8. And for the last one, Patient may have other nonspecific symptoms such as: nausea and
vomiting, hematemesis, melena, heartburn, and etc. these symptoms are not specific
because they can be seen in gastritis and other GI tract disease.

For the next slide, we would like to show you, how to distinguish the different manifestation
between gastric ulcer and duodenal ulcer.
For the gastric ulcer,
1. The Pain is usually appears in 2-3 hours after meal because of the acid secretion (or we
called it hunger pain). So, Hunger pain is Pain that often happens when person is hungry
about 2-3 hours after meals because this is the time when acid secreted in the absence of
food buffer.
2. It’s Night/nocturnal pain, which Often occurs around 11pm - 2am because at this time the
circadian stimulation of acid secretion occurs.
3. Pain can be relieved by meals, antacids which is an anti secretory agent , and alkali.

For duodenal ulcer,

1. The symptoms Usually aggravated by food, which means The pain is more likely to
display food provocation.
2. The pain is less likely to be relieved by food or antacids
3. And the pain Usually occurs within 1h after meals