One of the few indications for ulcer surgery that remains is the perforated ulcer. The role of Helicobacter pylori in ulcer recurrence after simple closure of a perforation has been unclear, and therefore, this randomized prospective trial of antihelicobacter therapy with a control group receiving a 4-week course of omeprazole is of great value. Of the 51 patients assigned to the treatment group, 5% had a relapse at the 1-year follow-up as opposed to 38% of the control group. Treatment consisted of a 1-week regimen of oral bismuth subcitrate, tetracycline, and metronidazole, in addition to omeprazole. Thus, within the limits of this study, it would seem prudent to pursue a conservative operative approach to the perforated ulcer, knowing that most patients can be spared ulcer recurrence by eradication of H pylori.