A patient reports epigastric pain that improves with eating. What is the leading diagnosis?

In the context of a patient presenting with epigastric pain that improves with eating, a duodenal ulcer is a leading diagnosis. This type of ulcer typically causes pain when the stomach is empty, and the pain often diminishes after food intake. This is because eating stimulates the production of gastric acid and bicarbonate, which can temporarily soothe the ulcer's irritation.

In contrast, cholecystitis usually presents with pain that is more related to fatty meals and may not have a pattern of relief with eating. Gastritis can cause pain, but it is often associated with discomfort that does not specifically improve with meals. Esophageal reflux, or GERD, typically causes pain that can worsen after eating or when lying down due to the backflow of stomach acid into the esophagus.

Thus, the nature of the pain and its response to food consumption lends strong support to a diagnosis of a duodenal ulcer in this case.