PUD typically presents with burning epigastric pain, though it may be described as sharp, dull, an ache, or an “empty” or “hungry” feeling. It may be relieved by the ingestion of food, milk or antacids, presumably due to an acid buffering or dilution effect. The pain recurs as the gastric contents empty and the recurrent pain classically awakens the patient at night. Atypical presentations are common in the elderly and may include no pain, pain that is not relieved by food, nausea, vomiting, anorexia, weight loss, and/or bleeding.