A 52-year-old man with a 10-year history of duodenal ulcer disease presents with epigastric pain. He has been on omeprazole 20 mg daily for 3 years. Upper endoscopy reveals a 1.5 cm ulcer in the duodenal bulb with clean base. Regarding the pathophysiology and clinical features of peptic ulcer disease, all of the following are true EXCEPT:

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