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Background: Helicobacter pylori ( H. pylori ) infects about 50% of the world population and is the major cause of chronic gastritis, peptic ulcers, and gastric cancer. Chronic H. pylori infection induces gastric mucosal precancerous lesions mostly in adulthood, and it is debatable whether these pathological conditions can occur in childhood and adolescents as well. Since this is a critical issue to determine if intervention should be offered for this population group, we investigated the gastric mucosal precancerous lesions in pediatric patients in an area in central China with a high prevalence of H. pylori and gastric cancer., Aim: To investigate the relationship of H. pylori infection and gastric mucosal precancerous lesions in children and adolescents in central China., Methods: We screened 4258 ward-admitted children and adolescent patients with upper gastrointestinal symptoms, and finally enrolled 1015 pediatric patients with H. pylori infection and endoscopic and histological data. H. pylori infection status was determined by rapid urease test and histopathological examination. Both clinical and pathological data were collected and analyzed retrospectively. Occurrence of gastric mucosal precancerous lesions, inflammatory activity and degree of inflammatory cell infiltration between H. pylori -positive and -negative groups were compared., Results: Among the 1015 eligible children and adolescents, the overall H. pylori infection rate was 84.14% (854/1015). The infection rate increased with age. The incidence of gastric mucosal precancerous lesions in H. pylori- infected children was 4.33% (37/854), which included atrophic gastritis (17 cases), intestinal metaplasia (11 cases) and dysplasia (9 cases). In H. pylori -negative patients, only 1 atrophic gastritis case [0.62%, (1/161)] was found ( P < 0.05). Active inflammation in H. pylori -infected patients was significantly higher than that in non-infected patients, and the H. pylori -infected group showed more severe lymphocyte and neutrophil granulocyte infiltration ( P < 0.001). In addition, endoscopy revealed that the most common findings in H. pylori -positive patients were antral nodularity, but in H. pylori -negative patients only superficial gastritis was observed., Conclusion: In children and adolescents, gastric mucosal precancerous lesions occurred in 4.33% of H. pylori- infected patients in central China. These cases included atrophic gastritis, intestinal metaplasia, and dysplasia. The data revealed an obvious critical issue requiring future investigation and intervention for this population group., Competing Interests: Conflict-of-interest statement: All authors declare that there are no conflicts of interests related to this work., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)