Roughness of gastric sinus mucosa with congestion suggests that it may be inflammation of gastric sinus, or it may be the manifestation of early gastric cancer. Normal gastric sinus mucosa is smooth, soft, red and white in appearance, predominantly red, mucosa without congestion, edema, erythema, erosion, ulceration and other manifestations. Gastric sinusitis is a chronic inflammatory cell infiltration with lymphocytes and plasma cells predominantly seen in the gastric mucosal layer. The main manifestations under gastric sinus are erythema, rough and uneven mucosa, mucosal edema, hemorrhagic spots, exudation and so on. Gastric cancer is prevalent in gastric sinus, cardia and gastric body. Early gastric cancer manifests as small polypoid depression or elevation, or flat, with rough mucosa, easy bleeding, or patchy congestion and erosion. To sum up, rough mucosa with congestion of gastric sinus may be gastric sinusitis or early gastric cancer, which needs to be combined with patient’s medical history, other auxiliary examinations and pathological results to make comprehensive judgment.