A 60-year-old man presents with epigastric pain after meals, with some nausea and vomiting. A burning sensation in the midepigastrium is relieved by antacids and H2 antagonists. Upper endoscopy demonstrates paired ulcers on both walls of the proximal duodenum. Which of the following represents the most common complication of this patient's duodenal disease?

Bleeding is the most common complication of peptic ulcer disease, occurring in about 20% of patients. Chronic blood loss due to occult bleeding is often a feature of peptic ulcers, whereas massive bleeding occurs less often. Perforation (choice D) is a serious complication that occurs in 5% of patients. Perforating ulcers are commonly encountered in the duodenum. Duodenal peptic ulcers do not undergo malignant transformation (choice B). The other choices are uncommon. Diseases associated with peptic ulcers include cirrhosis, chronic renal failure, hereditary endocrine syndromes (MEN-1), a1 -antitrypsin deficiency, and chronic pulmonary disease.Diagnosis: Duodenal ulcer, peptic ulcer disease