Table of contents

Atrophic gastritis

What's new

Added 2023 KCHUGR, 2021 AGA, 2019 BSG, and 2019 ESGE/EHMSG guidelines for the diagnosis and management of atrophic gastritis.



Atrophic gastritis is defined as a chronic inflammation leading to the loss of gastric glands, which can occur with or without metaplasia.
The pathophysiology of atrophic gastritis involves an immune response directed towards the parietal cells and intrinsic factor of the gastric body and fundus. This leads to hypochlorhydria, hypergastrinemia, and inadequate production of the intrinsic factor, which in turn results in the reduction of essential substances like hydrochloric acid and intrinsic factor.
The prevalence of atrophic gastritis worldwide is estimated at 25%, and the risk is 2.4 times higher in H. pylori-positive individuals.
Disease course
Clinically, atrophic gastritis can be asymptomatic or present with vague gastrointestinal symptoms. Complications such as pernicious anemia or gastric cancer can occur due to the condition's impact on the stomach's secretion of essential substances.
Prognosis and risk of recurrence
The prognosis of atrophic gastritis is influenced by the extent and severity of gland loss and the underlying cause. It can progress to gastric cancer, especially in patients with advanced stages of gastritis.


Key sources

The following summarized guidelines for the evaluation and management of atrophic gastritis are prepared by our editorial team based on guidelines from the Korean College of Helicobacter and Upper Gastrointestinal Research (KCHUGR 2023), the Italian Society of Digestive Endoscopy (SIDE/SIGE 2022), the American Gastroenterological Association (AGA 2021,2020), the British Society of Gastroenterology (BSG 2019), the European Society of Gastrointestinal Endoscopy...
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Screening and diagnosis

Diagnosis: as per AGA 2021 guidelines, Recognize that atrophic gastritis is defined as the loss of gastric glands, with or without metaplasia, in the setting of chronic inflammation mainly due to H. pylori infection or autoimmunity.
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Classification and risk stratification

Risk of malignancy: as per EHMSG/ESGE/ESP/SPED 2019 guidelines, Recognize that patients with chronic atrophic gastritis or intestinal metaplasia are at risk for gastric adenocarcinoma,
and patients with advanced stages of gastritis with atrophy and/or intestinal metaplasia affecting both antral and corpus mucosa are at higher risk for gastric adenocarcinoma.

Diagnostic investigations

Antibody testing: as per AGA 2021 guidelines, Consider obtaining anti-parietal cell antibodies and anti-intrinsic factor antibodies to assist in the diagnosis of patients with histology compatible with autoimmune gastritis.

More topics in this section

  • Serum pepsinogen levels

  • H. pylori testing

  • Evaluation of anemia

  • Screening for autoimmune thyroid disease

Diagnostic procedures

Diagnostic endoscopy
As per KCHUGR 2023 guidelines:
Consider performing image-enhanced endoscopy in addition to white light endoscopy to increase the diagnostic accuracy of intestinal metaplasia.
Do not rely on white light endoscopy findings to determine whether to perform a biopsy when considering a biopsy to confirm atrophic gastritis or intestinal metaplasia.

More topics in this section

  • Biopsy (general indications)

  • Biopsy (patients with anemia)

  • Biopsy (patients with polyps)

  • Histopathology

Medical management

H. pylori eradication: as per KCHUGR 2023 guidelines, Consider initiating H. pylori eradication therapy to improve atrophic gastritis in patients with Helicobacter-positive atrophic gastritis.

Specific circumstances

Patients with pernicious anemia
As per AGA 2021 guidelines:
Obtain an appropriate diagnostic evaluation for atrophic gastritis in patients with unexplained iron or vitamin B12 deficiency.
Perform endoscopy with topographical biopsies to confirm corpus-predominant atrophic gastritis for risk stratification and to rule out prevalent gastric neoplasia (including NETs) in patients with a new diagnosis of pernicious anemia.

Preventative measures

Prevention of progression
As per BSG 2019 guidelines:
Do not use NSAIDs or COX-2 inhibitors to reduce the risk of progression of premalignant lesions of the stomach.
Do not use antioxidants to reduce the prevalence of premalignant gastric lesions.

Follow-up and surveillance

Endoscopic surveillance: as per AGA 2021 guidelines, Decide on the optimal endoscopic surveillance interval in patients with atrophic gastritis or autoimmune gastritis based on individual risk assessment and shared decision-making.
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