BACKGROUND: Eradication of H. pylori (HP) in the setting of peptic ulcer disease (PUD) reduces the risk of recurrent bleeding. Although it is recommended in the setting of PUD, confirmation of HP eradication is not always performed. Our aim was to evaluate HP eradication confirmation and its impact on ulcer recurrence and bleeding in patients presenting with acute PUD. METHODS: Consecutive patients were identified who presented to our center with gastrointestinal bleeding (hematemesis, melena, hematochezia, or decrease in hemoglobin by 2 g/dL plus guaiac positive stool). Demographic, clinical, as well as endoscopic results were retrospectively collected from the time of the initial endoscopy and at every clinical contact thereafter for a minimum of 2.5 years. RESULTS: Between January 2000 and December 2004 a total of 127 individuals (mean age 68 ± 11 years) were endoscopically confirmed to have peptic ulcers. Age was positively correlated with the number of comorbidities present (r=0.33, p<0.001) as well as admission to the ICU (r= 0.19, p=0.03). The cause of the ulcers was identified as NSAIDs alone in 50 (39%), H. pylori alone in 20 (16%), NSAIDs and H. pylori in 37 (29%), and non-NSAID non-H. pylori in 20 (16%). Among the 57 individuals with H. pylori associated ulcer disease, 52 (91%) received antibiotic treatment, however confirmation of eradication was attempted in only 19 (37%), and among those tested, treatment was successful in 16 (84%). Emergent rebleeding occurred in 18 (14%) of the cohort overall, and was correlated with the need for emergency transfusion prior to the initial endoscopy (r=0.34, p=0.028). The number of ulcers found on the initial endoscopy was also positively correlated with the chance of rebleeding (r=0.32, p=0.014). The lowest rate of rebleeding (13%) occurred in the HP eradicated group, while the rebleeding rate for the failed eradication group did not differ significantly from the group where HP eradication was not confirmed (33% vs. 33%). During follow-up endoscopy there was a trend towards more non-healed ulcers in the no-treatment/failure group (66.7%), and the group without HP eradication confirmation (33%) compared to the group that was successfully eradicated (25%). CONCLUSIONS: H. pylori eradication is not confirmed in many patients with associated peptic ulcer disease. These missed opportunities are associated with increased rates of emergent ulcer rebleeding and reduced ulcer healing rates. Further studies are required in large cohorts to assess the impact of failure to confirm eradication in H. pylori-associated ulcer disease.