The lack of reliable molecular markers for normal differentiated epithelial cells limits understanding of human gastric carcinogenesis. Recognized precursor lesions for gastric adenocarcinoma are intestinal metaplasia and spasmolytic polypeptide expressing metaplasia (SPEM), defined here by ectopic CDX2 and TFF2 expression, respectively. In mice, expression of the bHLH transcription factor MIST1, normally restricted to mature chief cells, is down-regulated as chief cells undergo experimentally induced metaplasia. Here, we show MIST1 expression is also a specific marker of human chief cells. The mainstays of therapy in gastric carcinoma are early recognition, resection, and neoadjuvant or adjuvant therapy. However, gastric cancer remains the second largest cause of cancer-related mortality worldwide, 1 which drastically illustrates our lack of understanding of the sequence and progression of preneoplastic conditions. The traditional linear progression model of cellular changes, such as (Helicobacter-mediated) inflammation, atrophy, intestinal metaplasia (IM), dysplasia, and carcinoma, 2-4 does not apply to all cases and does not allow incorporation of more recently recognized entities. For example, there are distinct types of IMs, not all carrying definitive preneoplastic potential, and some authors have argued that IM in general is a paraneoplastic condition because the earliest gastric carcinomas arise from gasSupported by