Adherence to HEp-2 cells has been proposed as a virulence characteristic of enteropathogenic E. coli (EPEC). The role of the HEp-2 adherent E. coli was evaluated in a group of children with endemic diarrhea admitted to Hanyang University Hospital in Seoul, Korea. HEp-2-adherent E. coli was detected in fecal samples of 59 (59%) of 100 cases and ten (22.7%) of 44 concurrent control children (p<0.0005). Adherence was exhibited by 15 serogroups and subgroups, but within these groups more than one adherence pattern was frequently observed. Of 17 strains belonging to traditional infantile EPEC serogroups, 12(70.6%) gave a positive adherence. Of 45 enterotoxin producing strains, 24 (53.3%) gave a positive adherence. HEp-2-adherent strains that did not belong to classic EPEC serogroups and did not produce heat-stable and/or heat-labile enterotoxins(referred as enteroadherent E. coli, EAEC) was found in 29 (29%) of the patients with diarrhea and in six (13.6%) of the well children (p<0.05). From 22 of the 29 cases, no pathogen other than EAEC was isolated. These findings strongly implicate EAEC as the cause of diarrhea in the children. Our study supports the concept that EAEC may be an important cause of endemic diarrhea in Korean children.