Objective To evaluate the therapeutic effect of PPI or bismuth triple therapy for eradication of Helicobacter pylori(Hp) and 10-day sequential therapy or quadruple therapy for remedy eradication of peptic ulcer in the aged (PUA). Methods A total of 261 elderly patients with Hp caused peptic ulcer diagnosed by rapid urease method under gastroscope from July 2009 to July 2010 were randomized to receive one week of PPI or bismuth triple therapy for Hp first eradication. The adverse reactions were observed. Four weeks of anti-ulcer therapy by PPI and mucosa protectant were carried out after the Hp first eradication. The curative effect on Hp eradication and ulcer healing were compared at one month afterwards. All the patients who failed in the first Hp eradication randomly received 10-day sequential therapy or PPI and bismuth quadruple therapy for Hp remedy eradication. The adverse reactions were observed and Hp infection status was assessed by 13C-urea rapid breath test at one month after the medications stopped. Per protocol(PP) cohort analysis and intention-to-treat(ITT) cohort analysis were used. Results Compared with bismuth triple therapy, PPI triple therapy had higher Hp eradication rate[ITT: 77.7% vs 62.6%; PP: 79.5% vs 64.1%; P＜0.05] and higher ulcer healing rate[ITT: 78.5% vs 64.9%; PP: 80.3% vs 66.4%; P＜0.05]. There was no obvious difference in adverse reaction between the two strategies[ITT: 10.8% vs 16.8%; PP: 11.0% vs 17.2%; P＞0.05]. For Hp remedy eradication, 10-day sequential therapy had better Hp eradication effect[ITT: 84.6% vs 61.5%; PP: 86.8% vs 63.2%; P＜0.05] and lower adverse reaction rate[ITT: 12.8% vs 35.9%; PP: 13.2% vs 36.8%; P＜0.05]. Conclusions PPI triple therapy is the main choice on PUA patients for its better Hp eradication and ulcer healing effects. Ten-day sequential therapy is recommended to patients who failed Hp first eradication by triple therapy.