Gastric ulcer was studied with regard to the relationship with patterns of distribution of intestinal metaplasia (IM). 882 stomachs of elderly patients, obtained from autopsies from 1987 to 1991 were examined histopathologically. There were 74 open gastric ulcers and 88 ulcer scars. Distribution of IM was classified into 7 types. Open ulcers and scars were found more often in type O (IM found in the entire lesser curvature which is the most common type in the elderly) than in other types. Open ulcers in type O were mostly shallow and located in the IM area. Many open ulcers in type A (IM involving the antrum) and type B (IM involving both the antrum and cardia) were deep and on the boundary zone between the IM area and the proper gastric mucosa area. Most of the deep scars that did occur in type O were in the IM area but in types B and A most of them were located on the boundary zone. Scars in type O probably developed on the boundary zone when they were open ulcers and removed in the IM area because of progression of the IM area. In some cases ulcers were at the boundary zone of IM involving the cardia and this finding was characteristic of elderly cases.