The conclusions to be drawn from the report of Sung et al. could not be clearer: improvements in current endoscopic or pharmacological treatments for Peptic ulcer bleeding will have a small impact on the overall death rate. When optimizing the management of patients with Peptic ulcer bleeding, the aims should be to reduce the risk of multi-organ failure and cardiopulmonary death in an elderly population. Obviously, these are not easy tasks, but ones we will have to meet if we are to reduce Peptic ulcer bleeding-associated mortality.