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Which manifestation of peptic ulcer disease generally occurs first in an older adult?

According to studies, older adults with peptic ulcer disease (PUD) often experience a significant delay in diagnosis because their initial symptoms can be atypical and subtle compared to younger patients. Therefore, which manifestation of peptic ulcer disease generally occurs first in an older adult is frequently a severe complication, such as frank gastrointestinal bleeding or perforation, rather than the classic burning abdominal pain. This difference in presentation can contribute to higher rates of morbidity and mortality in the elderly.