Chronic atrophic gastritis with intestinal metaplasia was considered as gastric precancerous lesions.Exploring effective drugs for its treatment is of great significance in reducing the morbidity and mortality of gastric cancer.Aims: To study the efficacy of gefarnate for the treatment of chronic atrophic gastritis with intestinal metaplasia.Methods: A total of 133 cases of chronic atrophic gastritis with intestinal metaplasia were enrolled and randomly assigned into gefarnate group and control group.Patients in gefarnate group were given gefarnate 100 mg tid for 3 months,and patients in control group were given Weifuchun 1400 mg tid for 3 months.Before and 3 months after treatment,subtyping of intestinal metaplasia was demonstrated by AB-PAS and HID-AB staining,and the inflammation degree of gastric mucosa was determined by HE staining.Results: The rate of chronic atrophic gastritis with intestinal metaplasia reversed to nonatrophic gastritis(reversal rate) in gefarnate group was significantly higher than that in control group(32.84% vs.15.15%,P = 0.017) 3 months after treatment.The reversal rate of incomplete-type small intestinal metaplasia in gefarnate group was significantly higher than that in control group(48.28% vs.16.67%,P = 0.016).The reversal rate of complete-type small intestinal metaplasia in gefarnate group was higher than that in control group but not reaching statistical significance(33.33% vs.16.67%,P = 0.375).The reversal rate of small intestinal metaplasia was significantly higher than the reversal rate of colon metaplasia in gefarnate group(44.74% vs.17.24%,P = 0.018).The inflammation degree of gastric mucosa in gefarnate group was significantly lower than that in control group(χ2= 11.061,P = 0.011).Conclusions: Gefarnate is effective for chronic atrophic gastritis,and it can reverse incomplete-type small intestinal metaplasia.