Results of pathological studies of surgical specimens have led to widespread acceptance of the belief that with aging the gastric mucosa gradually becomes atrophic and the incidence of intestinal metaplasia increases. To distinguish natural age-related changes in the incidence of fundic gland atrophy and intestinal metaplasia from changes related to disease, we studied stomachs removed at autopsy from 187 people who had had no gastric diseases and were over 60 years old at the time of death (27 were over 100 years old). The autopsies were performed at Tokyo metropolitan geriatric hospital. None of the stomachs had circumscribed gastric lesions, and those found to have cancer or ulcer were excluded. Age at the time of death was not associated with the incidence of fundic gland atrophy or of intestinal metaplasia. Thus, the incidences of fundic gland atrophy and of intestinal metaplasia in elderly people were much lower than those found in studies of surgical specimens. In addition, the incidences of fundic gland atrophy and of intestinal metaplasia did not differ significantly between the sexes, regardless of age.