OBJECTIVE: To clarify the relationship between helicobacter pylori (Hp) infection, tongue manifestation and gastroscopic manifestation, and explore the mechanism of action of "oral-gastric microecology" in the occurrence and development of stomach-related diseases. MEDHODS: A total of 1100 patients were divided into Hp positive group and Hp negative group according to 13C breath test results. The tongue manifestation materials from patients were collected to make tongue printing slides for morphological observation of exfoliative cells from tongue coating, and electronic gastroscopy was performed on the patients and the data was analyzed. RESULTS: Hp infection rate was about 45.95%; and the greasy coating was mostly observed in Hp positive group (63.14%, P < 0.05). The total tongue coating distribution was as follows: yellow greasy coating (56.66%, P < 0.05) > yellow coating > white coating > white greasy coating. The gastric mucosal roughness and mucosal hematoplastic plaques in the two groups were more common in the Hp positive group (P < 0.05). There was a significant difference in the granular subgroup and in the rough mucosal group (P < 0.05). CONCLUSIONS: Hp infection is more commonly observed in yellow greasy coating, and this can be used as a reference for Traditional Chinese Medicine in determining whether it is Hp infection or not. Mucosal granule roughness, hyperemia, and oral Hp showed association with Hp infection in the stomach and interacted with micro-ecological environment that is composed of the oral cavity. (c) 2022 JTCM. All rights reserved.