Campylobacter pylori specifically attaches to gastric epithelial cells and is the etiologic agent for type B gastritis. The authors report the case of a woman with the rare finding of heterotopic gastric mucosa in the rectum that was colonized with C. pylori. Histologic findings of the heterotopic mucosa revealed active chronic gastritis that resolved when C. pylori was eradicated with bismuth subsalicylate and antibiotics. This is the first report of C. pylori in a location distal to the duodenum. The presence of live C. pylori organisms in the rectum suggests that viable organisms are present in the stool and that C. pylori may be spread by the fecal-oral route.