Question

A patient presents with epigastric pain that radiates to the back and is relieved by food. He has a history of similar pain in the past for which he was taking analgesics, and in the past 5 years he was operated twice for duodenal ulcer. The pain before and after surgery was controlled with proton pump inhibitors. What is the probable diagnosis?

• A. Gastric ulcer
• B. Duodenal ulcer
• C. Chronic pancreatitis
• D. Atrophic gastritis

Hint:

Pain relieved by eating, with prior duodenal ulcer surgeries, means duodenal ulcer.

Answer 1

The Correct Option is B

Step 1: Analyse the pain pattern. Epigastric pain that is relieved by food (and the classic hunger pain / night pain that improves on eating) is characteristic of duodenal ulcer, in contrast to gastric ulcer where pain typically worsens with food.
Step 2: Use the history. The patient has been operated twice for duodenal ulcer and responds to proton pump inhibitors, indicating recurrent acid-peptic disease of the duodenum.
Step 3: Eliminate the other options. Gastric ulcer pain is aggravated by eating. Chronic pancreatitis pain radiates to the back but is not relieved by food and is not controlled simply by PPIs. Atrophic gastritis causes reduced acid and is associated with malignancy risk, not food-relieved ulcer pain.
Step 4: Conclusion. The food-relieved pain, recurrent surgeries, and PPI response point to recurrent duodenal ulcer.