The clinical manifestations of duodenal bulb ulcers are diverse, some manifest as epigastric pain or pain radiating to the back, some are asymptomatic, some are hunger pains or nocturnal pains, which are relieved by eating, and a very small number of patients manifest epigastric fullness, nausea, vomiting, belching, or the appearance of black stools. In more serious cases, blood vomiting may occur, and even cause perforation of the duodenal bulb leading to severe abdominal pain; in some patients, the ulcer may cause pyloric or bulbar stenosis leading to repeated vomiting.