AIM: To conduct a detailed histological study of gastritis in adult patients attending an endoscopy clinic at a Kenyan teaching and referral hospital.METHODS: Biopsy specimens from consecutive patients were examined and graded according to the Updated Sydney System for H pylori infection, chronic inflammation, neutrophil activity, glandular atrophy and intestinal metaplasia. Also documented were gastric tissue eosinophil counts and presence of lymphoid follicles.RESULTS: The rate of the graded variables, in the antrum and corpus respectively, were as follows:H pylori infection (91%, 86%), chronic inflammation (98%, 93%),neutrophil activity (91%, 86%), glandular atrophy (57%,15%) and intestinal metaplasia (11%, 2%). Lymphoid follicles were noted in 11% of cases. Duodenal and gastric ulcers were documented in 32% and 2% respectively.The mean eosinophil count was 5.9 ± 0.74 eosinophils/HPF and 9.58 ± 0.93 eosinophils/HPF in the corpus and antrum respectively. Significant association was found between the degree of H pylori colonisation with chronic inflammation, neutrophil activity and antral glandular atrophy. Biopsies from the antrum and corpus showed significant histopathological discordance for all the graded variables.H pylori negative cases were associated with recent antibiotic use.CONCLUSION: The study reaffirms that H pylori is the chief cause of gastritis in this environment. The majority of patients show a moderate to high degree of inflammation but a low degree of glandular atrophy and intestinal metaplasia. The study shows that interrelationships between the histological variables in this African population are similar to those found in other populations worldwide including non-African populations.