Our understanding of ulcer pathogenesis has dramatically changed since the discovery of Heliobacter pylori. Peptic ulcer is now recognized as a chronic gastric infectious disease. H. pylori can be considered the pacemaker, with other known risk factors ultimately contributing to the ulcer formation. Treatment of H. pylori in peptic ulcer disease cures the acute lesion and prevents relapse and complications. In clinical management a positive diagnosis of H. pylori is required and other potential causes for ulcer formation must be excluded before starting treatment. The standard treatment in H. pylori positive ulcer consists of PPI in standard dose and two antibiotics either clarithromycin 2 x 500 mg and amoxycillin 2 x 1 g or metronidazole 2 x 400 mg and clarithromycin 2 x 250 mg (or 500 mg) for 7 days. The simultaneous presence of H. pylori and NSAID intake requires distinct management. Following bleeding complication a PPI needs to be given beyond 7 days until ulcer healing is endoscopically confirmed.