Background: Painless peptic ulcer bleeding is well recognized, although clinical features associated with the absence of abdominal pain have received little attention. Methods: Patients admitted for upper GI bleeding at a large inner-city hospital were questioned prospectively at the time of initial evaluation regarding the presence of any dyspepsia and/or abdominal pain, including nocturnal symptoms, within 1 wk of admission. A number of other clinical and endoscopic features were also recorded. The cause of upper GI bleeding was determined in most patients by endoscopy. Patients were excluded if a reliable history could not be obtained or if the ulcer was malignant. Results: Over the 50-month study period, 449 patients with upper GI bleeding caused by peptic ulcer were evaluated, including 236 with gastric ulcer (53 prepyloric) and 213 with duodenal ulcer (28 with channel ulcer). Of these patients, abdominal pain was absent in 191 (43%; 95% confidence interval, 38- 47%). There appeared to be no relationship of pain to race, gender, alcohol use, ulcer location, use and duration of nonsteroidal anti-inflammatory drugs, history of ulcer, or comorbidity. The only statistically significant correlates with abdominal pain were ulcer size (77% of patients with ulcers >2 cm reported pain as compared with 49% of patients with ulcers <1 cm; p < 0.001), tobacco use (p = 0.041), and age <80 yr (p = 0.02). Conclusions: Approximately half the patients with a bleeding peptic ulcer have no abdominal pain. Large ulcer size, use of tobacco, and age <80 yr seem to be the main determinants of ulcer-related pain in this setting.