Further Experience with Epigastric Pain Reproduction Test in Duodenal Ulceration

Further evidence is presented that the epigastric pain of duodenal ulceration, situated between the rib margins and just below the xiphisternum, arises from the lower oesophagus. One-hundred patients with duodenal ulceration were divided into those with epigastric pain (61) and those with pain in the upper abdomen but not in the epigastrium (39). Perfusion of 0·1 N HCl into the lower oesophagus reproduced epigastric pain in 53 of the 61 with epigastric pain (mean 37 ml) but in none of the 39 without (mean 125 ml). All those who had been woken by epigastric pain at night in the previous four weeks had a positive test. In five the test remained positive even though the acid was neutralized by a continuous perfusion of alkali just below the gastro-oesophageal junction. In another five 200 ml 0·1 N HCl instilled into the stomach for 21 minutes did not reproduce epigastric pain, even though 30 ml perfused for three minutes into the lower oesophagus did.