01, Table 4) but not depression scores than asymptomatic patients. According to one study, the majority of patients with an acute BPU are asymptomatic until life-threatening severe bleeding occurs. This remains a hitherto unexplained yet potentially important

observation.29 The findings from our current study provide a potential explanation. While we had hypothesized that patients with BPU might be less sensitive as compared to healthy controls, our data suggest that patients with uPUD are actually more sensitive than HC. Using a standardized test of visceral sensation, our findings show that patients with uPUD have an augmented symptom response whilst patients with BPU have a symptom response to a test meal that is not different from IWR-1 mw that in HC. Data on the prevalence of ulcer symptoms prior to ulcer bleeding are few. The proportion of patients

without symptoms has been reported to range from 43% to 87%.11,13,14,29 The systematic survey of our 3-MA cell line patients using validated questionnaires shows that the majority (83%) of patients with BPU are asymptomatic. In contrast, the majority of patients with uPUD usually present with abdominal pain. Our study also shows that after ulcer healing, or treatment that would reasonably be expected to have healed the ulcer, patients with uPUD continued to report symptoms that were more severe than those in patients with BPU. Persistent symptoms after healing of ulcers might be the result of post-inflammatory hyperalgesia, as occurs in an animal model of transient colitis.30 The patients were studied after cessation of PPI therapy and, potentially, rebound acid secretion

might have contributed to the persistence of symptoms.31 However, such effects would not explain the difference between patients with bleeding and uncomplicated ulcer disease. The major finding of this study is that patients with BPU have diminished gastric visceral sensation compared with uPUD. Similarly asymptomatic PUD patients, irrespective of bleeding status, have diminished visceral sensation compared MCE with patients who experienced peptic ulcer symptoms. These differences were present after ulcer healing, suggesting a fundamental difference in visceral sensitivity between patients with bleeding or asymptomatic ulcers and those with symptomatic or uncomplicated ulcers. Lowered visceral sensitivity and asymptomatic status is a plausible explanation for the presentation of ulcers with complications such as bleeding. Conversely, visceral hyperalgesia, higher degrees of psychological distress, more concomitant bowel symptoms and persistent dyspepsia after medical treatment in patients with uPUD may explain earlier presentation and diagnosis of the ulcers. The augmented symptom response to the test meal and the higher level of background symptoms after ulcer healing suggest that patients with symptomatic but uncomplicated peptic ulcers share similarities with patients with functional dyspepsia.