The accurate differentiation between duodenal ulcers and ulcers of the pyloric end of the stomach offers great difficulties. When a physician follows his patients from the examining room to the operating table he is forced to the conclusion that to locate a peptic ulcer is not only difficult but often impossible.
In reviewing the symptoms and diagnostic features of peptic ulcer I shall take the duodenal as the type. What holds good for duodenal ulcers, holds equally good for all ulcers situated in the pyloric end of the stomach. The chief difference arises from the degree in which the characteristic symptoms are manifest.
In this discussion I wish to emphasize but four points that seem to stand out prominently and clearly in the larger number of cases: First, the periodicity of attacks of gastric and duodenal ulcers. Second, the number of years through which these attacks and intermissions or remissions
GRAHAM C. PROMINENT SYMPTOMS IN THE DIAGNOSIS OF GASTRIC AND DUODENAL ULCERS. JAMA. 1908;LI(8):651–655. doi:10.1001/jama.1908.25410080017002c
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