Helicobacter pylori is a well known major causative agent of chronic gastritis. In general, the inflammation induced by this organism is a chronic active gastritis, which develops into atrophic gastritis. It is well established that atrophic gastritis is one of the major risk factors of intestinal gastric cancer. Thus, severe long-lasting gastritis induced by H. pylori infection is considered for treatment to prevent gastric cancer. We experienced a case of dramatic eradication of H. pylori using a fifth-line salvage therapy in a patient with H. pylori-induced active gastritis during four years of follow-up. (Korean J Helicobacter Up Gastrointest Res 2014;14:52-57)