In the Correa model of gastric carcinogenesis, Helicobacter pylori infection, atrophic gastritis, and intestinal metaplasia are associated with the development of gastric cancer. Low serum pepsinogen levels are known to be highly associated with extensive atrophic gastritis. High-resolution, high-magnification narrow-band imaging (M-NBI) allows detailed examination of the gastrointestinal mucosa. However, there are no comparative data on the usefulness of standard endoscopy and M-NBI for H. pylori infection and gastric precancerous conditions.