Helicobacter pylori eradication is the initial treatment of choice in localised low-grade gastric MALT (mucosa-associated lymphoid-tissue)-type lymphoma. We describe the natural course of seven patients who refused further oncological treatment for persistent lymphoma after successful eradication of H pylori. Despite persistent clonality, neither lymphoma progression nor high-grade transformation arose during a mean observation period of 34 (range 22-44) months. In view of the favourable course of these patients, a watch-and-wait strategy could be a valid approach to management of this disease.