Is epigastric tenderness a sign of peptic ulcer disease?

Abstract

This study was designed to determine whether epigastric tenderness on palpation is indicative of active peptic ulcer disease and to determine whether eliciting tenderness by different examiners is reproducible. Eighty-eight patients (52 males and 36 females) who complained of upper abdominal pain suggestive of peptic ulcer disease were the subjects of this study. Two to 72 h before endoscopy patients were tested for pain reaction to light and deep palpation by two independent examiners unfamiliar with them. There was complete agreement on the presence or absence of tenderness between the two examiners in 74 of 88 patients on superficial and in 75 out of 88 patients on deep palpation. Patients in whom there was disagreement were excluded, and the rest were classified according to whether or not they had tenderness on palpation. On the basis of subsequent endoscopic findings the patients were subdivided into three groups. Group 1: normal (upper abdominal pain but no endoscopic abnormalities), 37 patients; group 2: peptic ulcer disease, 25 patients; group 3: esophagogastroduodenal disease without gastroduodenal ulcer (esophagitis, gastritis, duodenitis, etc.), 26 patients. To determine the value of the clinical sign, sensitivity, specificity, and negative and positive predictibility of epigastric tenderness on light and deep palpation were calculated for each group. It was concluded that the physical sign of epigastric tenderness on light or deep palpation is insensitive, not specific, and has a low predictive value for peptic ulcer disease (group 2) or other esophagogastroduodenal disease (group 3). This sign may also be present in many (70% on deep palpation) individuals who complain of pain and who have no endoscopic or other evidence of organic gastrointestinal disorders (group 1) and therefore probably suffer from functional gastrointestinal disease.