A thiy-year-old male presents to the Emergency Depament with symptoms of epigastric pain radiating to back that wakes him up at night and is relieved by consuming food. He gives a history of similar pain in the past which was diagnosed as perforated duodenal ulcer and treated with omental patch surgery on two occasions. Pain before and after surgery has been controlled with proton pump inhibitors and analgesics. The likely diagnosis on this occasion is

In duodenal ulcer pain is more before food early morning and decreases after taking food these symptoms are classically called hunger pain, as pain is relieved by taking food, night pains are common, shows marked periodicity than gastric ulcer, tenderness is present on epigastric region whereas in gastric ulcer pain is in the epigastric region after taking food, lasting up to 2 hours, pain uncommon during the night In pancreatitis it&;s sudden onset of pain which is referred to back, pain is relieved after leaning forward Reference SRB edition 5 page no.825 ,823,685