Upper gastrointestinal bleeding (UGIB) is a common problem and frequently generates a consult for the acute care surgeon. Although very few patients with this complaint ultimately have any surgical intervention, surgeons have historically been intimately involved in the management of UGIB patients. With the discovery of Helicobacter pylori, effective H. pylori treatment and eradication regimens have greatly decreased the incidence of peptic ulcer disease as well as shifted the algorithm away from surgical treatment. Moreover, there appears to be a decreasing incidence and mortality of peptic ulcer disease as well as a decrease in acute UGIB related to peptic ulcer disease [1]. Recent data suggests that surgical intervention for any symptom or complication of peptic ulcer disease have declined more than 80 % [2]. Moreover, the fields of diagnostic and therapeutic endoscopy as well as interventional radiology have expanded in directions that have had a huge impact on the treatment options available for the patient with an UGIB. The role of the surgeon will often be to assist their colleagues in guiding the patient into an informed and evidence based plan of action.