Most Common Symptom of Acid Peptic Disorder
The most common symptom of acid peptic disorder is epigastric pain, which occurs in the majority of symptomatic patients and is the cardinal presenting feature of peptic ulcer disease. 1
Primary Symptom Presentation
Epigastric pain is the predominant symptom in symptomatic patients with peptic ulcer disease, though it's important to note that approximately two-thirds of patients with peptic ulcer disease are actually asymptomatic. 1
The epigastric pain may be accompanied by dyspepsia, bloating, abdominal fullness, nausea, or early satiety, but the pain itself remains the most characteristic feature. 1
Symptom Overlap and Diagnostic Considerations
Heartburn frequently coexists with epigastric pain in acid peptic disorders, with 63-66% of patients who have heartburn also experiencing coexisting epigastric pain. 2
However, heartburn alone is not a dyspeptic symptom and should be distinguished from epigastric pain—heartburn is characterized by a burning sensation that rises from the stomach or lower chest upward toward the neck, whereas epigastric pain is centered in the upper abdomen without this upward movement. 3, 2
Approximately 19% of patients with dyspepsia cannot select their predominant symptom when asked to differentiate between heartburn and epigastric pain, highlighting the diagnostic challenge. 4, 2
Clinical Characteristics of Epigastric Pain
In functional dyspepsia (which represents 80% of dyspepsia cases after endoscopy), the epigastric pain is typically located in the upper abdomen or epigastrium and may be present in fasting conditions and/or precipitated or exacerbated by meal ingestion. 4
Unlike irritable bowel syndrome, abdominal pain in acid peptic disorders is unrelated to the need to defecate, which helps differentiate these conditions. 4
Important Clinical Pitfall
- While epigastric pain is the most common symptom in those who are symptomatic, clinicians must remember that the majority of peptic ulcer patients are asymptomatic, which has significant implications for screening high-risk populations (such as NSAID users or those with H. pylori infection). 1