AIM: To determine if Fourier-transform infrared (FT-IR) spectroscopy of endoscopic biopsies could accurately diagnose gastritis and malignancy. METHODS: A total of 123 gastroscopic samples, including 11 cases of cancerous tissues, 63 cases of chronic atrophic gastritis tissues, 47 cases of chronic superficial gastritis tissues and 2 cases of normal tissues, were obtained from the First Hospital of Xi'an Jiaotong University, China, A modified attenuated total reflectance (ATR) accessory was linked to a WQD-500 FT-IR spectrometer for spectral measurement followed by submission of the samples for pathologic analysis. The spectral characteristics for different types of gastroscopic tissues were summarized and correlated with the corresponding pathologic results. RESULTS: Distinct differences were observed in the FT-IR spectra of normal, atrophic gastritis, superficial gastritis and malignant gastric tissues. The sensitivity of FT-IR for detection of gastric cancer, chronic atrophic gastritis and superficial gastritis was 90.9%, 82.5%, 91.5%, and specificity was 97.3%, 91.7%, 89.5% respectively. CONCLUSION: FT-IR spectroscopy can distinguish gastric inflammation from malignancy.