OBJECTIVE To evaluate the efficacy of triple eradication therapy versus symptomatic therapy in children with Helicobacter pylori-associated chronic active gastritis (H pylori-ACAG). METHODS Symptomatic patients with H pylori-ACAG (n=31) were randomly assigned into two groups: (1) patients infected with H pylori who were treated with triple eradication therapy (n = 16); and (2) patients infected with H pylori who were treated with symptomatic therapy (n=15). RESULTS After 1 year of follow-up, macroscopic appearance was significantly different in group B (P=.023), and chronic inflammation, H Pylori density, and activity were significantly higher in group B than in group A (P=.022, .007, and .002, respectively); however, we did not find a significant difference in the symptoms comparing both groups (P=.287). After 1 year of follow-up, we observed the persistence of the H pylori infection in all children who had not received eradication treatment. CONCLUSIONS There is no correlation between eradication of H pylori infection and improvement of dyspeptic symptoms. Self-eradication does not occur within 1 year of follow-up. A trend toward a higher rate of chronic inflammation in noneradicated children at 1 year limited the time of our study.