Past exam of the mathematics course of the University of Cambridge / 2017 / iii / Paper 105 / 1 / 2 / b / Solution

Repeated integration by parts against a compactly supported test function gives the bilinear formal adjointThere is no boundary remainder because $v$ has compact support. The product rule makes this an order-at-most-$m$ linear differential operator with real analytic coefficients. The displayed integral pairing has no complex conjugation, so this is the formal transpose; for a sesquilinear pairing the coefficients would be conjugated.

For uniqueness, suppose $Q$ is the difference of two candidates. Then $\int uQv=0$ for every smooth compactly supported $u$ and $v$, so $Qv=0$ for every such $v$. At an interior point, a polynomial times a cutoff can prescribe every derivative of $v$ through order $m$ independently. Hence each coefficient of $Q$ is zero. This proves uniqueness as a differential operator, not only uniqueness of its integrated action.