OBJECTIVE: To determine the prevalence and histological features of endoscopic nodular gastritis (NG) in adult dyspeptic patients and its relation to Helicobacter pylori infection. SUBJECTS AND METHODS: A retrospective endoscopic report review of 2,142 patients identified 67 patients with NG during the period from 1 September 2006 to 31 August 2007. A subset of 32 NG patients (group 1) who had had gastric biopsies during upper gastrointestinal endoscopy and had been evaluated for H. pylori infection were compared to 32 age- and gender-matched dyspeptic patients. They had undergone endoscopy during the same period, which yielded normal results, and had available biopsies that were similarly evaluated for H. pylori infection (controls, group 2). Pertinent clinical data were obtained from the patients' records. An experienced pathologist assessed the biopsies for the presence and grade of inflammation, activity, glandular atrophy, intestinal metaplasia, presence and density of H. pylori and presence of lymphoid follicles or aggregates. RESULTS: NG was identified in 67 (3.1%) patients. On histological examination, group 1 had a significantly higher grade of gastritis (p < 0.001). The presence and density of H. pylori infection was significantly higher in group 1 (p < 0.001). The H. pylori density correlated significantly with the severity of gastritis (r = 0.57, p < 0.001). The endoscopic performance of NG on H. pylori infection had high specificity (96.8%) and positive predictive value (93.3%). CONCLUSION: This study outlined the clinicopathological features of NG identified among a cohort of dyspeptic patients in Kuwait and confirmed the close association with H. pylori infection. However, our study has a limitation in that histopathologic assessment of all NG patients was not feasible.