Objective To investigate the prevalence of serum Helicobacter pylori(Hp) infection in the patients with upper gastrointestinal symptoms and the relationship between Hp antibody groups and pathological changes under gastroscopy. Methods A total of 705 patients including 389 males and 316 females underwent gastroscopy from August 2018 to January 2020 (age between 13 and 88 years). Four Hp antibodies were detected by immunoblotting, and the infection rates of type Ⅰ and type Ⅱ Hp were multiple compared by sex and age groups(every 10 years old, which were≤30, 31~≤40, 41~≤50, 51~≤60, 61~≤70, ≥71 years). Divided into superficial gastritis, superficial gastritis with erosion, esophagitis, chronic atrophic gastritis, gastric ulcer and gastric cancer groups through gastroscopy. The positive rates of HP antibodies detected between groups were compared, and the data of detected antibodies including toxin-related protein cytotoxin-associated protein(CagA), vacuolating cytotoxin gene(VacA) and CagA+VacA were collected and analyzed. Results The total HP infection rate was 60.6%, and the infection rate of Hp type Ⅰ in was higher than that of Hp type Ⅱ. The HP infection rates in male were 59.4% (231) and 62.0% (196) in female, and didn’t show difference (χ²=0.510, P=0.475). Age into 6 groups with Hp infection rate (P<0.05), Hp Ⅰ infection rate within each age group (P<0.05). The gastric cancer group had highest positive rate of Hp Ⅰ(60.0%), while the esophagitis group had highest rate of Hp Ⅱ (17.5%), significant difference between type Ⅰ positive rate (P<0.05). In the cases with positive Hp Ⅰ, the CagA positive rate in gastric cancer was 70.6%, the VacA positive rate in superficial and erosive gastritis was 17.0%, and the positive rate of CagA+VacA in esophagitis was 52.0%. Conclusions Hp infection is a key cause of the most gastric diseases. Hp Ⅰ is currently the most common type of Hp infection in the clinic, which is more pathogenic.