Objective：To analyze the consistency between the histopathological results of routine endoscopy and biopsy in observing the gastric mucosa of patients with non-malignant gastroduodenal diseases, and to evaluate the necessity of biopsy following gastric endoscopy. Methods.. From Jan. 2005 to Dec. 2005, 320 patients who received upper gastrointestinal endoscopy and biopsy because of upper abdominal symptoms were included in this study. The patients were selected consecutively according to their disorders diagnosed by macroscopic endoscopy and were divided into 64 groups. The 5 patients in each group had reflux esophagitis, non-atrophic gastritis, atrophic gastritis, gastric ulcer and duodenal ulcer, respectively. Patients in the same group were matched with each other in gender, age and their history of diseases. The results of endoscopy, including the exudation, congestion, erosion, roughness, bile reflux, etc. , were read by 2 experienced endoscopists. The biopsy was performed by an experienced pathologist and pathological variables included active inflammation, chronic inflammation, atrophy, intestinal metaplasia and atypical hyperplasia. The status of Helicobacter pylori （H. pylori） infection was evaluated by rapid urea test, silver staining and histological methods; the result was deemed positive when the results of either 2 tests were positive. Results： Erosion, exudation, roughness, and H. pylori infection were related with active inflammation; erosion and H. pylori infection were related with chronic inflammation; roughness of mucosa was related with atrophy; roughness and H. pylori infection were related with intestinal metaplasia; and obsolete hemorrhage, H. pylori infection, roughness mucosa, and bile reflux were related with atypical hyperplasia. Macroscopic diagnosis rate of atrophic gastritis was 71.9% （46/64） with a false positive rate of 28.2 % （18/64） and a false negative rate of 34.38% （22/64）. Conclusion： Macroscopic diagnosis is indicative to pathological changes of gastric mucosa, but the predictive value is relatively poor, making biopsy and pathological examination necessary in the diagnosis of gastric mucosa disorders during routine endoscopic examination.