1, what need to do gastroscopy upper gastrointestinal symptoms (including esophageal, gastric and duodenal source of symptoms) lack of specificity, according to the severity and type of symptoms, can not be clearly differentiated from gastroesophageal reflux, gastritis, gastric ulcers, duodenal ulcers, tumors of the upper gastrointestinal tract, or simple dyspepsia, and therefore require further examination or treatment observation. According to clinical epidemiological studies, endoscopy is needed for Han Chinese people with upper gastrointestinal symptoms who are older than 45 years old or (although they may be less than 45 years old,) with so-called alarm symptoms such as vomiting blood, black feces, wasting, severe pain, and so on. 2, how to treat Helicobacter pylori infection China’s adult Helicobacter pylori infection rate of about 50%, with age increases, Helicobacter pylori infection rate increases. Not all H. pylori infected individuals need H. pylori eradication. Recommendations for eradication treatment are for those with established upper gastrointestinal symptoms, a family history of gastric cancer in a first-degree relative (parent, sibling, child), existing ulcers or a history of previous ulcers, and established more severe chronic or dysmorphic gastritis. 3, atrophic gastritis is not far from gastric cancer (what is intestinal metaplasia, will it become cancer) Atrophic gastritis is gastric mucosal inflammation accompanied by atrophy, and the degree of harm does not lie in the atrophy, but mainly in the concomitant inflammation and atrophy accompanied by intestinal metaplasia and atypical hyperplasia. It is the unstable intestinal metaplasia and atypical hyperplasia that have an elevated chance of malignancy. With age, the gastric mucosal glands decrease (that is, atrophy) is a normal physiological phenomenon. Therefore, a certain extent and degree of atrophy of the gastric sinus mucosa is inevitable. Age-related mild-to-moderate atrophy, like wrinkles on the skin, is a normal concomitant of aging and will not be completely reversed, nor does it need to be completely reversed. For excessive (beyond age-related) atrophic changes, there is some degree of recovery with the removal of the cause accompanied by a reduction in inflammation. Intestinal chemosis is a feature of the gastric mucosa that takes on the characteristics of the intestinal mucosa after repair of damage to the gastric mucosa. In a sense, intestinal chemosis is an adaptive phenomenon in a localized environment (bile acids, inflammatory activity), i.e., mild small intestinal-type chemosis is not harmful. If the etiology (H. pylori, bile acids, inflammation, etc.) persists, damage continues to occur, intestinal chemosis worsens, or an unstable large bowel type of chemosis is present, there is a risk of further malignancy. Atypical hyperplasia, endothelial neoplasia, and allopatric hyperplasia are all concepts in the same sense. It is the phenomenon of unstable hyperplasia that carries the risk of malignant transformation. Mild atypical hyperplasia, low-grade intraepithelial neoplasia, and mild heterogeneous hyperplasia require aggressive treatment and endoscopic follow-up (usually requiring a 1-year review). Severe atypical hyperplasia, severe heterogeneous hyperplasia and high-grade intraepithelial neoplasia require immediate endoscopic review, and endoscopic minimally invasive treatment is generally recommended if there are limited changes. 4, acid inhibitors long-term use of safety Proton pump inhibitors have a good safety. No evidence has been found that long-term use promotes carcinoid tumor or gastric cancer. There are concerns that long-term use may increase the chance of infection and the risk of osteoporosis. There is no evidence of adverse reactions in pregnant women or adverse effects on the fetus.