Background and Objective: Gastric cancer is a common cancer in East-Azerbaijan (Northwest of Iran). In a community with high rates of gastric cancer, dyspepsia may be a symptom of a serious problem. The main aims of this study were to evaluate the gastric mucosal changes in dyspeptic patients from Azerbaijan and to compare it with similar patients from Hormozgan (a community with low rates of gastric cancer in the South of Iran). Materials and Methods: In this analytic-descriptive setting, 191 patients with dyspepsia were evaluated at the Tabriz Liver and Gastrointestinal Diseases Research Center. Upper endoscopy was done in all patients and biopsies were obtained from 5 different points of the stomach, followed by histopathological assessments. Results: A total of 101 patients from Azerbaijan (so-called Azari)‍‍ and 90 patients from Hormozgan (so-called Bandari) were enrolled. Endoscopically determinable lesion was significantly more frequent in the patients from Hormozgan (68.3% case vs. 81.1% control x2test P=0.03). HP infection was determined in 69.3 and 84.1 percent of the patients from Azarbayjon and Hormozgan, respectively. Active chronic and chronic gastritis were found in 72.3% and 23.8% of Azari group and 73.6% and 25.3% of Bandari group. In those patients with gastritis, corpus predominant or pangastritis was more common in the Bandari group (64.1% Azari vs. 83.3% in the Bandari). Chronic gastritis (Mean scores 10.96±2.8 Bandari v 8.5 ± 3.2 Azari, P<0.001, u=2494) and active gastritis (Mean scores 7.6 ± 5.7 Bandari vs. 3.4 ± 3 Azari, P<0.001, u=2572) were severe in the Bandari group. No cases of displasia and adenocarcinoma were detected. Conclusion: Our findings show that endoscopically determinable lesion, HP infection, chronic and active chronic gastritis of gastric mucosa, and the corpus predominant or pangastritis were more common in the patients from Hormozgan.