ABSTRACT Background: Cirrhosis is a great health problem worldwide and is associated with many complications. Portal hypertensive gastropathy (PHG) is one of its most common complications and in some patients may lead to gastrointestinal bleeding. The relationship between Helicobacter pylori (H. pylori) infection and PHG is not clearly identified. Objective: This work aimed to study a possible association between H. pylori infection and PHG and to correlate the severity of PHG with H. pylori infection in cirrhotic patients. Methodology:A cross sectional comparative study included 90 cirrhotic patients, who were classified into 3 groups. G1: included 30 age and sex-matched cirrhotic patients with no PHG. G2: included 30 age and sex-matched cirrhotic patients with mild PHG. G3: included 30 age and sex-matched cirrhotic patients with severe PHG. Endoscopic examination was done to evaluate the presence and severity of portal hypertensive gastropathy and for diagnosis of H. pylori infection. Results: H. pylori infection by histopathology was detected in 61 studied patients (67.8%). H. pylori infection was more prevalent among cirrhotic patients with PHG (78.3%) than patients without PHG (46.7%) (P=0.0029). H. pylori infection was detected in 26(86.7%), 21(70.0%), 14(46.7%) in patients with severe, mild and no PHG respectively. H. pylori infection was more prevalent in patients with severe PHG relative to patients with no PHG (p-value = 0.001). Conclusion: The current study showed a significant relation between H. pylori infection and PHG in cirrhotic patients and it might have a role in the pathogenesis of severe PHG.