“Atrophic gastritis” on an endoscopy or biopsy report describes a chronic change in which the normal secretory glands of the stomach lining decrease or disappear over time.
Atrophic gastritis is not cancer. But it is different from ordinary redness of the stomach; its cause, its extent and any accompanying changes should be assessed.
What causes atrophic gastritis?
The two most important causes are:
- Helicobacter pylori (H. pylori) infection
- Autoimmune gastritis
The process related to H. pylori can lead over time to atrophy of the stomach lining.
In autoimmune gastritis the immune system affects the cells in the corpus and fundus of the stomach in particular. As a result, B12 deficiency and pernicious anaemia can develop in some patients.
How does it look at endoscopy?
An atrophic stomach lining can look:
- Thinner than normal
- Paler
- With the vessels beneath the mucosa showing more clearly
But biopsy and pathological examination matter in assessing atrophy definitively.
Why is a biopsy taken?
A biopsy allows assessment of:
- Whether atrophy is present and how widespread it is
- H. pylori
- Intestinal metaplasia
- Other accompanying microscopic changes
A biopsy being taken does not mean there is cancer.
Is atrophic gastritis cancer?
No. Atrophic gastritis is not stomach cancer.
That said, in some people — particularly those with widespread atrophy and intestinal metaplasia — the risk of developing stomach cancer in the future can be increased.
So the same approach is not applied to everyone. The location and extent of the atrophy, intestinal metaplasia, H. pylori status, family history and other risk factors all matter in the decision about follow-up.
What problems can it lead to?
Atrophic gastritis causes no symptoms in many people. Some patients may have indigestion, bloating or early fullness.
In autoimmune gastritis particularly, B12 deficiency, iron deficiency and anaemia can develop. So in patients who need it, blood count, iron/ferritin and B12 levels are assessed.
Is there a treatment?
Treatment is directed first at the cause.
If H. pylori is present, appropriate eradication treatment is given. In autoimmune gastritis, consequences such as B12 and iron deficiency are looked for and treated where needed.
Not every patient with atrophic gastritis needs to take a stomach-protecting medicine continuously.
Is follow-up needed?
In some patients, yes. But not every patient with atrophic gastritis has an endoscopy at the same interval.
The need for follow-up is decided individually according to the extent of the atrophy, the presence of intestinal metaplasia, family history and other risk factors.
When should you see a doctor?
Do not delay if these accompany it
Unexplained anaemia or iron deficiency, B12 deficiency, unintended weight loss, persistent vomiting, difficulty swallowing, vomiting blood or black stools.
Remember
- Atrophic gastritis Is not cancer.
- H. pylori Is one of its important causes.
- Autoimmune gastritis Can be associated with B12 and iron deficiency.
- A biopsy Matters in assessing atrophy and intestinal metaplasia.
- Follow-up Is not the same for every patient; it is decided according to risk.
This is not enough to make a diagnosis
When atrophic gastritis is suspected at endoscopy, the biopsy result, H. pylori status, the location and extent of the atrophy and whether there is intestinal metaplasia all have to be weighed together.
Sources
- Prof. Ali Tüzün İnce, MD