Background and Aims: Acute hemorrhagic esophagitis is recognized as stress-induced mucosal injury and one of the uncommon source of upper gastrointestinal tract bleeding as well as hemorrhagic erosive gastroduodenitis. It has not been discussed whether H. pylori infection influences on these hemorrhagic mucosal lesions. The study aimed to evaluate the prevalence of H. pylori infection between patients with esophagitis and gastroduodenitis. Methods: The study included 116 patients who presented with upper gastrointestinal tract bleeding, and diagnosed as having hemorrhagic esophagitis (group A, n = 38), or hemorrhagic gastroduodenitis (group B, n = 78) by emergency esophagogastroduodenoscopy. Their clinicopathological findings, and the status of H. pylori infection were compared with each other group; H. pylori infection was determined by urease test, serology, and histology. Results: Mean age and sex ratio of patients in group A were 72.6+−12.9 yr, range 34-89, and M:F = 21:17, and those in group B were 63.1+−15.8yr, range 23-84, and M:F = 45:33, respectively. Elderlys more than 70 yr of age were more predominant in group A (71.1%) than group B (47.4%) (p < 0.005), although no gender difference was noted. All patients in group A had background diseases such as cerebrovascular disease 31.6%, dementia 21.1%, diabetes 15.8%, ischemic heart disease 10.5%, though 32.1% of patients in group B had no background diseases. 89.5% in group A and 41.0% in group B received institutional care with nursing (p < 0.0005), and 34.2% in group A and 11.5% in group B were bedridden (p < 0.01). NSAIDs users and alcohol consumers were estimated as 18.4%, 15.8% in group A and 25.6%, 19.2% in group B, respectively (p = n.s). All of the hemorrhagic lesions in group A located in the lower third of the esophagus involving esophago-gastric junction, while in group B 62.8% of hemorrhagic lesions confined to the stomach, and 37.2% were associated with bulbitis. The prevalence of H. pylori infection was significantly lower in group A (29.2%) than in group B (73.6%) (p < 0.0005). The histology of background gastric mucosa revealed that atrophy, active inflammation, and intestinal metaplasia were found in 36.8%, 31.6%, 5.3% in group A, and 72.9%, 66.1%, 17.7% in group B, respectively (p < 0.05-0.005). Conclusion: Hemorrhagic esophagitis occurred exclusively in the elderlys who were inpatient or nursed supine for the underlying diseases. Majority with hemorrhagic esophagitis were negative for H. pylori, which suggested a scanty contribution of H. pylori infection to them, although H. pylori infection might have a certain relation to hemorrhagic gastroduodenitis.