The treatment of primary gastric lymphoma is controversial. The role of surgery 
has come to be questioned with increasing knowledge about the pathogenesis of 
gastric lymphoma and with new therapeutic approaches such as eradication of 
Helicobacter pylori. We review published clinical trials of primary gastric 
lymphoma, including preliminary results of our own prospective multicenter 
trial. The results of 7 trials of H. pylori eradication and 12 prospective 
therapeutic trials trial are discussed. On basis of these data it is concluded 
that surgery with intention of R0 resection is the treatment of choice in stages 
EI2 and EII1 of low-grade lymphoma. In high-grade lymphomas it is still unclear 
whether surgery or its primary combination with radio- or chemotherapy should be 
preferred. The eradication of H. pylori is a promising therapeutic approach for 
localized low-grade mucosa-associated lymphoid tissue lymphoma. A randomized 
trial is needed to clarify whether medical or surgical management of localized 
gastric lymphoma or a combination of two is the best treatment modality.