The functional role of histamine H 4 receptors (H 4 Rs) in the Gastrointestinal (GI) tract is reviewed, with particular reference to their involvement in the regulation of gastric mucosal defense and inflammation. H 4 Rs have been detected in different cell types of the gut, including immune cells, paracrine cells, endocrine cells and neurons, from different animal species and humans; moreover, H 4 R expression was reported to be altered in some pathological conditions, such as colitis and cancer. Functional studies have demonstrated protective effects of H 4 R antagonists in several experimental models of gastric mucosal damage and intestinal inflammation, suggesting a potential therapeutic role of drugs targeting this new receptor subtype in GI disorders, such as allergic enteropathy, Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS) and cancer.