44–46 In the present study, the age BI6727 difference between patients with BPU and uPUD, or symptomatic and asymptomatic PUD was only 10 years. Thus it is unlikely that age is a major determinant of differences in symptom status in our patients. Male gender may also be associated with asymptomatic PUD. In the present study, men formed the majority of asymptomatic patients and were significantly less common in the symptomatic group. Whilst ulcer size has been reported to be a determinant of symptoms,13,16 we did not detect an effect of either ulcer size or location on symptoms after a meal challenge in this study. The study also shows that patients with uncomplicated or

symptomatic ulcers reported significantly higher scores for anxiety but not depression than patients with BPU and HC. Psychological factors, especially anxiety, are associated with gastrointestinal symptoms in patients with functional gastrointestinal disorders47 and in the general population.48 It has also been shown that click here self-reported PUD, presumably due to symptomatic ulcers, is associated with a generalized anxiety disorder.49 Gastric sensorimotor function can be altered by experimentally-induced anxiety in healthy subjects, which suggested that psychological factors may play a role in dyspeptic symptoms even though those subjects did not

have psychological disorders.50 Such observations may explain why patients with dyspeptic symptoms reported anxiety scores higher than asymptomatic peptic ulcer patients. However, the mechanism of the association between psychological factors and dyspeptic symptoms remains unclear. This

study has some unavoidable limitations. First, we were not able to assess visceral sensation in patients with asymptomatic uPUD as these patients do not seek any medical attention and the ulcers are found only serendipitously or when complications occur. Second it might be argued that the size of ulcers in the uPUD group was relatively small and, in some cases, were over-diagnosed erosions. However, we set criteria based on those previously published and accepted20,21 and all, in contrast to erosions, had depth. The small size of the ulcers in some patients can be explained by the use of NADPH-cytochrome-c2 reductase PPI therapy before the endoscopy. Third, the questionnaires were completed 8 weeks after the diagnosis. However, it appeared problematic to assess the dyspeptic symptoms immediately after the ulcer presentation with, in some cases, very life-threatening manifestations. Nevertheless, the BDQ addressed the patients’ symptoms over the previous 12 months, which included the period before PUD was diagnosed. The findings of this study have implications for our understanding and management of PUD. Normally, visceral pain is one of the reasons patients seek medical attention.