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Objective: To assess prevalence of Helicobacter pylori infection, reasons for referral for gastroscopy, and clinical findings of gastroscopy in a symptomatic First Nations population in northwestern Ontario from 2009 to 2011., Design: Three hundred four hospital charts of symptomatic patients who underwent upper endoscopy between June 2009 and March 2011 were reviewed., Setting: Meno Ya Win Health Centre in Sioux Lookout, Ont., Participants: First Nations patients with dyspepsia undergoing gastroscopy., Main Outcome Measures: Reason for referral, and clinical and histologic findings on gastroscopy., Results: The most common reasons for referral for gastroscopy were dyspepsia (59.2%) and undiagnosed anemia (18.1%). Overall, 66.8% of patients underwent biopsies; 37.9% of these patients tested positive for H pylori. Gastritis was encountered the most often, in 46.1% of patients; gastric ulcers in 6.9% of patients; and normal gastric mucosa was seen 36.8% of the time. The rate of H pylori infection is higher than in urban Canadian populations, but lower than in previous aboriginal prevalence estimates, particularly those based on seroprevalence values., Conclusion: This study raises the clinical question of how eradication testing and treatment protocols should be addressed in remote regions with high disease prevalence. As more is learned about the role H pylori infection plays in serious gastrointestinal diseases, rural and aboriginal populations might need a special focus on testing availability and treatment close to home.