With the possible exception of some esophageal ulcers, this study deals almost wholly with the experiences of patients harboring peptic ulcers. The symptoms commonly accepted as being diagnostic of peptic ulcer may be experienced by patients who do not have ulcer, and certain intrinsic gastro-intestinal lesions, such as benign tumor or carcinoma, occasionally produce symptoms clinically indistinguishable from peptic lesions. On the other hand, extensive or subacute perforating peptic lesions have often been observed among patients whose histories had lost to an appreciable degree the symptoms previously so characteristic for peptic ulceration.
Although there is a fairly consistent reduplication of characteristics in the syndrome of peptic ulcer, there is nevertheless much variability in the symptoms. This variability does not necessarily represent individual responses to the same morbid process, although changes in symptoms can often be noted in the same patients at different stages of the life cycle of the disease.
RIVERS AB. PAIN IN BENIGN ULCERS OF THE ESOPHAGUS, STOMACH AND SMALL INTESTINE. JAMA. 1935;104(3):169-174. doi:10.1001/jama.1935.02760030001001