The patient's symptoms are highly characteristic of a duodenal ulcer.

Question

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The patient's symptoms are highly characteristic of a duodenal ulcer.

Burning epigastric pain: This is a common symptom for various upper gastrointestinal conditions, including ulcers.
Pain improves after meals: This is a classic distinguishing feature of duodenal ulcers. Food buffers stomach acid, temporarily relieving the pain. In contrast, gastric ulcer pain often worsens with meals.
Wakes up at night due to pain: This is also a hallmark symptom of duodenal ulcers, as acid secretion is high during the night, and there is no food to buffer it.
Smoker: Smoking is a significant risk factor for peptic ulcer disease.
No NSAID use: This rules out NSAID-induced ulcers, making other causes like H. pylori or idiopathic more likely.

Considering these points, a duodenal ulcer is the most fitting diagnosis.

The correct option is B.

\boxed{\text{B. Duodenal ulcer}}

Answer