Despite universal trends of declining mortality rates, gastric cancer remains a major health problem. The advent of endoscopy has made a major impact in the diagnosis and management of early gastric cancer as well as of the premalignant lesions of the stomach. Nevertheless the disagreement between Japanese and Western histopathologists regarding the nomenclatures of the gastric precancerous lesions resulted in different recommendations and therapeutic guide lines. On this background we review the current concepts related to premalignant lesions, especially intestinal metaplasia and gastric dysplasia as well as the critical role of Helicobacter pylori in the evolution of these lesions. Additionally, this extensive review deals with the majority of precancerous conditions related to gastric adenocarcinoma and provides surveillance and therapeutic guidelines.
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