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Few data are available on childhood Helicobacter pylori gastritis and its relation to age. We investigated pathologic changes in gastric mucosa of children and adults of different age. Materials and Methods: Gastric mucosa specimens of 74 children (age range 1-18 years) were compared with those of 51 adults (age range, 2970). All had H. pylori gastritis without peptic ulcer. Morphologic analysis according to the Updated Sydney System and morphometric analysis to determine inflammatory cell the density (cell/mm2) were performed. Results: Pangastritis was less frequent in children (92% vs. 100% in adults, p = 0.03) and morphologic scores were significantly lower in children than in adults (4 vs. 6, p = 0.0002 in the antrum; 4 vs. 7, p = 0.000 in the corpus). Children had lower density of all cell types, and lower frequency of neutrophils' infiltration than adults in the corpus (54% vs. 78%, p < 0.009). In both groups a significant correlation was found between morphologic scores and neutrophils' density in the antrum (r = 0.608, p < 0.0001 in children; r = 0.881, p < 0.0001 in adults) and in the corpus (r = 0.780, p < 0.0001 in children; r = 0.908, p < 0.0001 in adults). Atrophic gastritis (4%) and intestinal metaplasia (1%) were exceptional in children and significantly more frequent in adults. Conclusions: Inflammation in childhood H. pylori gastritis is milder than in adults because of lower neutrophil prevalence and density in gastric mucosa. Pangastritis is less frequent in children but a constant finding in adults. Atrophy and intestinal metaplasia are rare in childhood gastritis. There is a good correlation between morphologic scores and morphometric evaluation of H. pylori gastritis both in children and adults. The Updated Sydney System seems suitable for evaluation of gastritis also in children. [ABSTRACT FROM AUTHOR]