Follicular gastritis is an importanthistological entity, because it may progress to overtgastric MALT lymphoma. However, there is no universalagreement on whether there is any correlation offollicular gastritis with histological features of theantral mucosa or on the prevalence of folliculargastritis. To shed further light on these issues, westudied antral biopsies obtained from 735 adultpatients, who had participated in six consecutiveclinical trials. They included 348 patients withduodenal ulcer, 82 with gastric ulcer, and 305 withnonulcer dyspepsia. The Sydney classification system ofgastritis was used, using a score of 0-3 to grade degreeand activity of inflammation, gland atrophy, intestinalmetaplasia, and H. pylori colonization density.Follicular gastritis was defined as prominent lymphoid follicles with no lymphoepithelial lesion. Noneof the H. pylori-negative patients (N = 159) hadfollicular gastritis. Among H. pylori-positive patients,80/340 (23.5%) with duodenal ulcer, 5/77 (6.5%) withgastric ulcer, and 20/159 (12.6% ) with nonulcerdyspepsia had follicular gastritis (P < 0.001).Multivariate discriminant analysis selected thefollowing four significant predictor variables for follicular gastritis (Wilks λ =0.91, x2 = 70.6, df = 4, P < 0.001):gastritis sum score, atrophic gastritis, age of thepatient, and disease. The prevalence of folliculargastritis was linearly correlated (y = 24.55 – 0.98x, r =–0.62, F1,11 = 6.12, P = 0.03) with theage groups of the 576 H. pylori-positive patientsstudied. In conclusion, follicular gastritis is highlycorrelated with H. pylori-caused severe, activegastritis. It is mostly prevalent in the young H.pylori-infected patients with duodenal ulcer.