The American Journal of Gastroenterology has published guidelines on the diagnosis and management of gastric premalignant conditions, addressing significant gaps in clinical practice for conditions that can progress to gastric adenocarcinoma. The guidelines provided evidence-based recommendations for endoscopic surveillance among high-risk patients, performance of high-quality endoscopy for diagnosis, histologic assessment criteria, and treatment strategies for gastric atrophy, gastrointestinal metaplasia, dysplasia, and certain gastric epithelial polyps. It emphasized the critical health disparity of gastric cancer in the United States and outlined 22 formal recommendations across seven domains, providing concrete targets for training and quality initiatives in the endoscopic management of gastric premalignant conditions.