With methylene blue dye spraying endoscopy 392 Japanese outpatients with gastric diseases, and 253 Japanese and 84 Canadian outpatients free of gross findings in the stomach were investigated on chronic atrophic gastritis in special reference to intestinal metaplasia. Second, with the same technique 176 asymptomatic healthy residents in Kyoto, Japan, were also investigated, in which 50 residents were followed for two years and 32 subjects for four years. In each population subjects, with increasing age the fundic-pyloric (F-P) border shifted cephalad indicating atrophy of the fundic mucosa. Japanese subjects, however, showed greater variation in location of the F-P border, and also greater in symptomatic outpatients than in asymptomatic healthy subjects. The reduction in fundic gland area with aging was followed by intestinal metaplasia. In addition, our follow-up study indicates that atrophic gastritis was most likely to advance gradually with increasing age, even in asymptomatic residents.