A duodenal ulcer typically presents with rhythmic, gnawing or burning epigastric pain that appears 2–3 h after meals or during the night and is promptly relieved by food, milk or antacids. Many patients also note early satiety, bloating, nausea and occasional retching; weight loss may occur because pain discourages eating. Pain can radiate to the back, and if an ulcer penetrates posteriorly it may cause continuous, non-relenting backache. Complications include sudden, severe, diffuse abdominal pain with board-like rigidity (perforation) or passage of black, tarry stools (bleeding). Alarm features—persistent vomiting, unexplained weight loss, anaemia, or recent onset of progressive symptoms—require urgent evaluation to exclude malignancy.