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It remains controversial whether gastric atrophy is reversible after Helicobacter pylori eradication therapy.To clarify whether gastric atrophy improves after H. pylori eradication therapy using a histologic approach.Subjects were 87 H. pylori infection-cured patients (treatment group) and 29 continuously H. pylori-infected patients (control group). The subjects in the treatment and control groups were followed for 10–49 months (mean, 22 months) and 11–50 months (mean, 22 months), respectively. Biopsy specimens were obtained from the greater curvature of the antrum and corpus at the beginning and end of the observation period; histologic analyses of these specimens were performed for detection of activity, inflammation, atrophy, and intestinal metaplasia. Results were scored without any clinical information according to the Sydney system.In the treatment group, the histologic score for atrophy was improved in the corpus but not in the antrum. Intestinal metaplasia was not improved in either the antrum or the corpus. There were no significant differences during the follow-up in gastric atrophy and intestinal metaplasia in the control group.Gastric atrophy was improved in the corpus ≈2 years after H. pylori eradication therapy.