Nine hundred and eighty patients presented with upper-gastrointestinal tract bleeding or perforation in a ten-year period. Thirty patients satisfied the criteria of having acute stress ulceration. Gastric and duodenal ulceration were found with equal frequency but gastric ulceration was more likely to be multiple. Sepsis occurred in 53% of these patients and is thought to be a significant factor. Surgically treated patients had a survival of 64% while nonoperative patients had a 5% survival. Early operative management is recommended to improve survival. Gastrectomy with vagotomy is recommended as the procedure of choice for bleeding acute stress ulceration while omental patching of a perforation is recommended.