therapy has improved, and a long postoperative life is usual in a majority of these patients with early-stage gastric carcinoma [1]. However, in these patients, the gastric remnant (GR) retains the mucosa that had been the background of the initial cancer, and the mucosa exists in nonphysiological circumstances. Thus, the possible development of a second primary cancer in the GR has been a problem. In practice, the incidence of a second primary cancer in the GR is considerably high. At our institute, second primary cancer in the GR was found in approximately 2% of the patients after curative resection of primary gastric carcinoma [2]. Thus, post-operative endoscopic surveillance has been emphasized to detect curable early-stage cancer in the GR [3].Our previous study demonstrated that the features of early-stage second primary cancer in the GR were somewhat different from those of ordinary primary gastric carcinoma; protruding lesions and intestinal type cancer were dominant, and the background mucosa of these lesions was often associated with atrophic gastritis or intestinal metaplasia [2,4]. Although the real cause of gastric carcinogenesis is not fully understood, several environmental factors, including infection with Helicobacter pylori, have been shown to be linked with gastric carcinogenesis [5]. Since Warren and Marshall [6] first isolated H. pylori from the stomachs of patients with gastritis, numerous studies have demonstrated the relationship between H. pylori infection and the development of gastric cancer [7][8][9][10]. Now, H. pylori is regarded as a definite carcinogen [11] and as a trigger for the sequence of carcinogenesis, because there is strong evidence for H. pylori infection as a cause of chronic atrophic gastritis and intestinal metaplasia, two possible precancerous lesions [9,10,[12][13][14]. Our previous observations on the background mucosa of early-stage carcinoma of the GR also indicated an intimate association between atrophic gastritis and intestinal-type gastric carcinoma [2]. Thus, involvement of H. pylori in carAbstract Background. The development of a second primary cancer in the gastric remnant after gastrectomy for early gastric carcinoma is a problem, and eradication of Helicobacter pylori after the operation has been recommended. However, to date, practical indications for H. pylori eradication after gastric cancer surgery have not yet been reported. Methods. We examined H. pylori infection in the gastric remnant after distal gastrectomy for primary gastric cancer. One hundred and nine patients who had had a gastrectomy were studied. Endoscopic findings and results from the urease test, bacteriologic assessment, serological test, and histopathological examination were analyzed. Results. Seventy-one patients (65.1%) were judged to be positive for H. pylori infection. The prevalence of H. pylori infection was found to be significantly decreased in older patients, patients in whom the operation had been performed a long time before examination, patients with symptoms, and pati...