Our study also quantified the risks of gastric cancer among patients with some other gastric mucosal findings. The incidence of gastric cancer among patients with atypia was 4.2-fold higher than in the matched general population. The excess was numerically beyond that observed among patients with intestinal metaplasia. This might be partly attributed to the ongoing debate on the definitions of atypia and dysplasia.22 23 Histologically, atypia refers to the presence of cells with cellular abnormalities following rapid cell multiplication under a damaging stimulus. In the case of persistent cellular atypia, typically in the background of thickened epithelium (metaplasia), the term dysplasia should be applied. However, under microscopy it can be challenging to distinguish atypia from dysplasia. This is especially true for endoscopic biopsy samples where architectural changes are difficult to assess owing to poor tissue orientation and limited amount of material.24 Moreover, previous histological studies found that the strictly defined atypia indeed commonly co-occurs (49-78%) with gastric cancer.25 26 Such atypia is therefore considered to be a neoplastic lesion and it has been renamed as “pit dysplasia.” Consistent with previous investigations, benign tumours,27 non-intestinal metaplasia, polyps,22 28 and hyperplasia29 were all associated with an increased risk of gastric cancer, although the excesses were moderate. Conversely, for reactive gastropathy (an abnormality in the stomach caused by chemical injury), no excess risk for gastric cancer was noted.30