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Background/Aims Only a few studies have evaluated the correlations between serum pepsinogen (PG) and histology after eradication of Helicobacter pylori. The aim of this study is to evaluate the effect of H. pylori eradication on intestinal metaplasia correlated with serum PG with a long-term follow-up. Methods From December 2006 to February 2019, we prospectively enrolled 347 subjects with successful H. pylori eradication. H. pylori tests (Giemsa stain, CLOtest, and culture) were performed to evaluate H. pylori status. Histological assessment was performed in the antrum and corpus by Sydney classification. Subject without histological intestinal metaplasia (IM) (grade=0) was excluded. Serum PG levels were measured using a Latex-enhanced Turbidimetric Immunoassay (Shima Laboratories) before and after eradication, compared by using linear mixed model. The follow-up points were classified as less than 12 months, 12 to 23 months, 24 to 35 months and more than 36 months. Results In H. pylori-eradicated group mean serum PG I (65.4 vs 53.0, p<0.001) became significantly lower and mean PG I/II ratio (3.35 vs 5.07, p<0.001) became higher at less than 12 months after eradication compared to those at baseline (Table 1). This improvement of PG values after eradication maintained during all follow-up points. The mean IM grade in the antrum (1.73 vs 1.21, p<0.001) and body (1.63 vs 0.94) became significantly lower at less than 12 months after eradication compared to those at baseline (Table 1). This improvement was also maintained during all follow-up points. Conclusions There was an association between serum PG levels and improvement of IM grade at the long-term follow-up after H. pylori eradication. [ABSTRACT FROM AUTHOR]