Mortality and hospital admission rates for peptic ulcer in England and Wales have fallen in the past twenty years. Within this pattern there has been a wide range of variation. Perforated ulcers have become less common in young adults, and perforated gastric ulcers in young men now occur with between a quarter and a tenth of their previous frequency. Perforated duodenal ulcer has become more common in middle-aged and elderly women. The reasons for these changes are not understood, but they are likely to reflect the impact of environmental influences on people of different ages.