Background: Helicobacter pylori related gastritis is a major health ailment in developing nations. There is high morbidity and mortality ranging from chronic gastritis to gastric malignancies. Prevalence of H. pylori infection varies markedly from country to country and in a country, region to region. Aim: To study the prevalence of H. pylori gastritis in patients undergoing endoscopy and its association with the development of gastrointestinal diseases. Subjects and Methods: The study was carried out in a Medical College Hospital in Kerala, India. Patients presenting with dyspeptic symptoms were subjected to upper gastrointestinal endoscopy and investigated for H. pylori infection through histopathological examination and rapid urease test of biopsy specimen. Diagnosis of H. pylori infection was made if one or both diagnostic test results were positive. Data analysis was carried out using the statistical package for social sciences, for Windows version 16.0 (SPSS 16; Chicago, IL, USA). Results: H. pylori infection was diagnosed in 62.0% (329/530) of patients screened. There was no statistically significant difference in sex and age related distribution (<50 year age group and >50 year age group) of H. pylori infection. However, a statistically significant association of H. pylori infection with the presence of endoscopic abnormalities, peptic ulcer, and dysplasia/cancer was seen. Conclusion: The prevalence of H. pylori infection is significantly high in rural and suburban population of Ernakulam district, Kerala. Early detection and prompt treatment are essential for prevention of serious complications.