Background/aims <p>The beneficial effects of <i>Helicobacter pylori (H. pylori)</i> eradication are likely associated with improvements in precancerous gastric lesions, such as gastric atrophy and intestinal metaplasia (IM). We aimed to evaluate the changes in endoscopic atrophy and IM before and after eradication.</p> Methods <p>From January 2014 to October 2021, we consecutively recruited 353 asymptomatic subjects who tested positive for rapid urease tests for <i>H. pylori</i> infection during screening endoscopy for gastric cancer. <i>H. pylori</i> was successfully eradicated, as confirmed by UBT, and they underwent at least one additional follow-up endoscopy. We compared endoscopic mucosal images obtained before and after eradication.</p> Results <p>After <i>H. pylori</i> eradication, an increased frequency of IM was observed (<i>P</i> = 0.001). Endoscopic corpus mucosal atrophy (subepithelial visible vessels) showed improvement only in the post-eradication closed-type endoscopic atrophic border (EAB) by Kimura-Takemoto (<i>P</i> = 0.001). Approximately 81.8% of post-eradication EABs were closed types, and corpus mucosal atrophy in these cases improved compared to pre-eradication closed-type EABs (<i>P</i> = 0.013); 51% of the open-type EABs improved to closed types; the newly formed closed types, constituting 15.6% of the post-eradication closed types, demonstrated a higher prevalence of corpus mucosal atrophy (<i>P</i> = 0.004) in comparison to the pre-eradication closed types.</p> Conclusion <p>Endoscopic atrophy and IM changes were observed after eradication. The enhanced prevalence of post-eradication IM was associated with an improvement in <i>H. pylori</i>–associated inflammation. The improvement in mucosal atrophy was confined to the post-eradication closed types, some of the post-eradication closed types demonstrated more severe corpus mucosal atrophy than the pre-eradication closed types.</p>