Peptic ulcer disease: epigastric tenderness did not help diagnose peptic ulcer disease.

Clinical bottom line (level 4)

  1. Patients who had epigastric tenderness on light or deep palpation were not clearly more likely to have peptic ulcer disease (or endoscopically verifiable gastroesophageal disease).
Priebe et al: Gastroenterology 1982; 82: 16-19
Expires January 2003

The study

Setting: two acute hospitals, Canada

88 patients (aged 19 to 88; mean ~40, 59% male) complaining of epigastric pain, undergoing endoscopy for gastric ulcer found on barium meal, non-diagnostic abnormality on barium study, upper GI haemorrhage or normal upper GI series but persistent abdominal pain

Excluded if
  • abdominal pain could be explained by pancreatitis, hepatobiliary or other nonesophagogastroduodenal intraabdominal abnormalities.
  • previous peptic ulcer surgery
  • examiners disagreed about their clinical findings



    • Independent blinded reference standard, applied in some patients from a non-consecutive inappropriate spectrum.
    Reference standard:
    • endoscopy: peptic ulcer disease
    Diagnostic test:
    • superficial palpation
    • deep palpation

    The evidence


    diagnostic test peptic ulcer disease no peptic ulcer disease LR+
    (95% CI)    		 LR-
    (95% CI)
    light palpation 1 12 0.17
    (0.024 to 1.26)     		1.3
    (1.1 to 1.5)
    total 24 50


    diagnostic test peptic ulcer disease no peptic ulcer disease LR+
    (95% CI)    		 LR-
    (95% CI)
    deep palpation 12 37 0.69
    (0.45 to 1.1)     		1.8
    (1.0 to 3.3)
    total 24 51


    diagnostic test gastroesophageal disease no disease LR+
    (95% CI)    		 LR-
    (95% CI)
    light palpation 6 8 0.46
    (0.18 to 1.2)     		1.2
    (0.94 to 1.6)
    total 46 28


    diagnostic test gastroesophageal disease no disease LR+
    (95% CI)    		 LR-
    (95% CI)
    deep palpation 29 20 0.91
    (0.66 to 1.3)     		1.2
    (0.61 to 2.3)
    total 46 29

    K intraobserver superficial palpation: 0.56
    K intraobserver deep palpation: 0.65

    Comments

    1. Abdominal examination may be valuable in narrowing a differential diagnosis.
    2. Post-test probabilities are meaningless in a pre-selected group like this one.

    Citation

    1. Priebe WM, DaCosta LR, Beck IT: is epigastric tenderness a sign of peptic ulcer disease?. Gastroenterology 1982; 82: 16-19
    Contributor: Chris Ball and Clare Wotton, Unknown Month 1999
    Reviewer: Zoltan Bodnar

    Clinical Question.
    Patient upper abdominal pain
    Intervention or Exposure epigastric tenderness on palpation
    Outcome peptic ulcer disease