Epigastric pain is a common complaint throughout Africa, mostly in the form of non-ulcer dyspepsia. It has recently been suggested that Helicobacter (= Campylobacter) pylori, a bacterium that colonizes the gastric mucosa and causes type B gastritis, may be the cause of this epigastric pain. This paper reports the endoscopic, histological and bacteriological findings in 57 patients presenting with epigastric pain to the University of Maiduguri teaching hospital during one year, together with a review of the African literature. Of 57 patients, 49 had non-ulcer dyspepsia, 7 peptic ulceration and 1 carcinoma of the stomach. 93% of the patients had histological gastritis, and of these 87% were colonized with H. pylori. The bacterium was cultured from 13 patients. This high prevalence of gastritis and H. pylori has been found throughout Africa. The figures support a causative role for H. pylori in histological gastritis. At present the evidence in support of a causative role in non-ulcer dyspepsia is not strong enough to be able to recommend the routine use of anti-H. pylori therapy in patients with epigastric pain.