Development of anti secretory agents with acid suppression has significantly reduced surgical patients with peptic ulcer. Recent researches have demonstrated that an eradication of HP diminishes ulcer recurrence. In contrast, the number of perforated peptic ulcer is not decreasing. However, clinical characteristics of perforated duodenal (PDU) and gastric (PGU) ulcer suffering from HP infection have not been well studied. Purpose: To clarify characteristics of PDU and PGU patients, and find clues of current management for perforating ulcer disease. Method: In the latest 2 years, records of PDU and PGU patients treated in our hospital were reviewed. Non-surgical, conservative therapy was adopted in the patients as follows, 1. Less than 65 years old, 2. Hospital arrival in less than 6hours after severe symptoms occurred, 3. Do not have serious general complications, 4. Accumulating small amount of ascites localized in the subphrenic cavity. Results: 23 (M; 18, F; 5) patients visited our emergency room. They consisted of 18 PDU (mean age 47) and 5 PGU (mean age 69). 14 cases (61%) did not have past history of peptic ulcer, and in 12 cases (52%), severe epigastralgia suddenly occurred without any symptoms relating peptic ulcer. Only 3 patients received medical treatment for peptic ulcer at the time of perforation. There was no case showing duodenal and pyloric stenosis. Rate of HP infection was 94% in PDU and 33% in PGU. Only 33% of PDU received operations, while 86% of PGU underwent surgical therapy according to our criteria. The operative procedures include omental plombage with drainage (6cases), drainage (3 cases), distal gastrectomy (1 case), and SPV with pyloroplasty. In only one case, conservative therapy was converted into surgical treatment to drain subphrenic abscess. Mean durations of nasogastric tube insertion, fasting period, and admission were 5.0 vs. 7.6 vs. 11.5, and 16.3 vs. 25.3 (conservative vs. surgical), respectively. Mortality rate was 4.3 % (1 patient), who died of septic shock just after arrived at our hospital. Conclusion: Half of the PGU and PDU patients did not have past history of peptic ulcer, and perforation suddenly occurred without any sign of peptic ulcer. Most cases of PGU need surgical treatment while PDU can be treated non-surgically. In PDU, as positive rate of HP infection is very high and no pyloric stenosis was observed, good long-term results can be expected by eradication of HP after curing perforating disease.