The increase in life expectancy demands that more attention be given to gastrointestinal problems, such as peptic ulcer disease, in elderly people. This review summarizes many of the physiological changes that have a role in peptic ulcer disease in elderly patients. How Helicobacter pylori infection modifies the course of peptic disease is also reviewed. The clinical presentation of peptic diseases often differs in elderly people, and atypical symptoms are common. Accurate diagnosis requires aggressive endoscopic evaluation. Treatment regimens using H2 receptor antagonists, proton pump inhibitors and regimens to eradicate H pylori may also need to be altered in elderly patients.