Liang Y, et al. - The current study sought to investigate the clinicopathological characteristics of granulomatous gastritis (GG) in different etiologies, especially Crohn disease (CD), as well as the role of H. pylori and the clinical significance of isolated GG. Two hundred sixty-nine GG cases overall (0.19% prevalence) were identified: 220 had an underlying granulomatous disease (CD, sarcoidosis, tuberculosis) and only 8 of these (3.6%) had H. pylori, fewer than the 10.3% rate among non-GG biopsies. In patients with granulomatous disease, GG does not correlate with H. pylori, but it may be associated with the organism when a proper diagnosis is not available. Younger age and upper gastrointestinal (GI) symptoms are correlated with a new CD diagnosis in CD patients with GG, while multiple gastric granulomas and a lack of upper GI symptoms are associated with lower GI granulomas. GG, even in isolated cases with no prior clinical history or granuloma, most likely represents CD, especially in younger, male patients or those with single, antral granulomas or upper GI symptoms.