Background: Obesity nowadays becomes a major medical and social problem in the world. Obesity is a pandemic health problem recognized as a disease of time and is also an important cause of morbidity and mortality. The aim of this study was to investigate the persistent histopathologic changes after Helicobacter pylori (H. pylori) treatment in laparoscopic sleeve gastrectomy (LSG) specimens and correlation between high body mass index (BMI) and histopathological findings. Materials and Methods: Asymptomatic 520 patients were candidate for laparoscopic sleeve gastrectomy (2017-2019) who had not symptom of Helicobacter pylori infection, visually normal endoscopy and had positive H. pylori urease recently. They treated with triple regimen (clarithromycin, amoxicillin for 2 weeks and proton-pump inhibitor (PPI) for 2 month). Eradication was confirmed by urea breath test (UBT). After operation specimens were evaluated histopathologically. Results: Females were 58.3% of the patients. Mean BMI were 44.2 (females) and 46.3 (males). Normal LSG specimens were 58.3%. Most common abnormal histopathology findings were; chronic mild active and inactive gastritis (21.3%), chronic moderate active and inactive gastritis (16.0%), chronic severe active and inactive gastritis (3.3%), had not follicular gastritis, lymphoid aggregates (0.6 %), intestinal metaplasia (0.2%) and PPI effect (0.2%). Significant correlation was observed between the higher patients BMI (BMI>45) with abnormal histopathology findings specially moderate and severe degree of chronic active and inactive gastritis. Conclusion: Patients with higher BMI was at more risk for post H. pylori treatment abnormal pathology like chronic active gastritis which is the risk factor for atrophic gastritis may lead to preventable gastric cancer. Patients with higher BMI (≥45) and H. pylori positive urease test with visually normal endoscopy, mainly candidate for the laparoscopic Roux-en-Y gastric bypass (LRYGB). Permanent endoscopic follow up in these patients are impossible, therefore, endoscopic random tissue mapping even after H. pylori treatment is appropriate.