BACKGROUND: Peptic ulcer bleeding is a common and potentially fatal condition, with an unchanged mortality of 4-14 % the last two decades despite progress in technical and medical treatment. NSAID and Helicobacter pylori are major risk factors for developing a bleeding peptic ulcer, and rebleeding occurs in approximately 20-22 %. Death is more common among elderly due to reduced baseline risk and comorbidity. The high mortality rate is still seen as a challenge, furthering research on endoscopic and pharmacological methods in order to treat these patients sufficiently. OBJECTIVE: To present the evidence of existing treatment regimes, assess the efficiacy of these and outline the options for patients in different risk groups. METHODS: A search in PubMed and the Cochrane Collaboration was conducted for metaanalyses and reviews over a 10-year-span on treatment of peptic ulcer bleeding. RESULTS: Risk identification, resuscitation and additional treatment with proton pump inhibitors (PPI) are crucial elements contributing to the success of endoscopic hemostasis. Endoscopic means per se are minimally different in efficiacy and the endoscopist is thus free to choose. A combination of injection and thermal coagulation or clips has proven most effective. Eliminating risk factors after stabilizing the patient, such as NSAID discontinuation and H. pylori-eradication, is of utmost importance. CONCLUSIONS: Acute peptic ulcer bleeding is a multifactorial condition requiring treatment on different levels. The patient should not receive treatment that merely seeks to stop the haemorrhage, but also one that stratifies and improves the functional and psychosocial level of the patient. Compliance and self-medication should be assessed, especially in older patients. This might not reduce mortality but rather the risk of complication and also increase the quality of life.