DUs perforate more commonly than GUs

The symptoms of perforation secondary to peptic ulcer disease typically develop suddenly

• epigastric pain, later becoming more generalised
• patients may describe syncope

Investigations

• Although the diagnosis is largely clinical, UptoDate recommend that plain x-rays are the first form of imaging to obtain
• An upright ('erect') chest x-ray is usually required when a patient presents with acute upper abdominal pain
• This is a useful test, as approximately 75% of patients with a perforated peptic ulcer will have free air under the diaphragm