To investigate the effect of morphological change ofHelicobacter pylori on gastric mucosal inflammation,H. pylori was examined by means of an electron microscope and computer-assisted three-dimensional reconstruction before and after antibacterial therapy. The results showed that the bacterium was usually present in different forms and sizes. Most of these variations are helicobacter shaped, 3–5 m long (43%), or campylobacter shaped, 1–3 m long (38%); fewer are round or coccoid (19%), and only 0.5–1 m long. Active inflammation and an abnormal amount of mucus in the epithelial cells are the main changes seen in gastric mucosa withH. pylori infection. In some cases, 6 weeks after antibacterial therapy,H. pylori could still be observed by toludine blue, with slight positive results withH. pylori-antibody-labeled immunostaining. In contrast to the bacteria before antibacterial therapy, in mostH. pylori-positive cases usually only a minute number of bacteria were seen in coccoid form. These surviving coccoid-form bacteria showed thickened walls, and the surrounding periplasmic space was reduced or nonexistent. The epithelial cells were almost normal and¹³C-text negative. Although neutrophil infiltration was seldom seen, there were still some surviving bulblike cells with excess amounts of mucus in the gastric pits. It is suggested that the coccoid form ofH. pylori may be a static bacterium without urease production. For therapeutic decisions, it may be more important to identify whether there is an active inflammation in the gastric mucosa than to detectH. pylori.