Helicobacter pylori (H. pylori), a pervasive pathobiont, colonizes the gastric mucosa and plays a crucial role in the pathogenesis of several gastroduodenal pathologies ranging from chronic gastritis to more severe disorders including peptic ulcer disease, gastric mucosa-associated lymphoid tissue lymphoma, and gastric adenocarcinoma. In symptomatic patients, endoscopy and histological examination of the gastric mucosa are the preferred tests for diagnosing H. pylori. Our study aimed to identify the frequency of H. pylori and its association with endoscopic and histopathological findings in adult Lebanese patients. Thus, 332 symptomatic adult patients, attending the Endoscopy unit of Makassed General Hospital in Beirut, were enrolled in this cross-sectional study. Overall, 14.16 % of the patients were infected with H. pylori, with male predominance. The most common endoscopic findings were gastritis and gastropathy. Moreover, H. pylori infection was significantly associated with gastric ulcers and duodenitis. On the other hand, active gastritis and chronic gastritis were the most common histopathological findings. Chronic gastritis was more frequent in H. pylori-positive patients. The association between endoscopic diagnosis and histopathological findings was then assessed. It was shown that gastropathy was significantly associated with chronic gastritis. In addition, gastric ulcer was significantly related to active gastritis and chronic gastritis. In conclusion, this study reported various endoscopic findings in H. pylori-positive patients based on the Kyoto classification. This highlights the importance of invasive diagnosis in symptomatic patients. Therefore, a combination-based approach including endoscopic and histopathological findings remains crucial in clinical practice for a definitive and accurate diagnosis of H. pylori infection and related disorders, especially in resource-limited settings.