Thirty-six isolates of H. pylori from up to three gastric biopsy sites (antrum, corpus and fundus) from 13 patients in Italy with different degrees of histological gastritis were investigated. All strains were tested for motility, cytotoxicity and degree of adhesion, and were typed by analysis of ribosomal RNA gene patterns (ribopatterns). Seventeen different DNA types (ribotypes) were identified, with each patient possessing H. pylori of one or more unique types. Only two patients had identical H. pylori at three sites. Most patients had H. pylori with different ribotypes or subtypes, but nine strains were not typable. Five patients had the same strain colonizing two of the three sites and atypical strains were mostly from the antrum. A complex pattern of H. pylori colonization in the stomach of some individuals was evident and suggested multiple sources of infection. No consistent associations were detected between degree of gastritis and adherence, cytotoxicity and motility but a 2.56Kb rRNA gene fragment that had a higher frequency in strains associated with severe gastritis than mild gastritis, may provide a useful molecular marker for future pathogenicity studies.