<prompt> 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 patients duodenal disease?BleedingMalignant transformationObstructionPerforation  <response>: 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 