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

The single most discriminating clue in this vignette is the timing of pain relative to meals. Pain in the epigastrium that eases when the patient eats reflects the buffering effect of food on duodenal acid load, which is the signature of duodenal ulcer; gastric ulcers behave oppositely, with food provoking pain. Reinforcing this, the man has a documented duodenal ulcer that has required two operations within five years and that responds to acid suppression with proton pump inhibitors, all of which describe persistent or recurrent duodenal acid-peptic disease. Running through the distractors confirms the choice: a gastric ulcer would worsen after eating, chronic pancreatitis indeed bores to the back but is not relieved by food nor adequately controlled by a PPI alone, and atrophic gastritis is a low-acid state linked to pernicious anemia and cancer risk rather than food-relieved ulcer pain. Putting the meal-relief pattern together with the surgical history and PPI response, the diagnosis is duodenal ulcer.\[\boxed{\text{Duodenal ulcer}}\]