Gastric cancer remains the second biggest cause of cancer death worldwide. The most common type of gastric cancer, the intestinal type, is usually preceded by chronic atrophic gastritis. Gastritis serology is therefore of crucial importance for population-based screening and prevention studies. Helicobacter pylori serum antibodies can adequately diagnose inflammation of the gastric mucosa, but the serological diagnosis of atrophic gastritis is more hazardous. Many tests have been used for this purpose, either alone or in various combinations. Depending on the population, pepsinogens and gastrin often have a high specificity but low sensitivity for the diagnosis of atrophic gastritis, whereas antibodies against H. pylori or CagA have a high sensitivity but low specificity. A combination of two tests, e.g. H. pylori antibodies and pepsinogen I, may balance this issue and provide adequate screening tools, although there is a clear need for further improvement and simplification of serological testing for atrophic gastritis.