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Atrophic gastritis

Last updated: July 16, 2021

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Atrophic gastritis is a condition characterized by chronic inflammation of the gastric mucosa with atrophy, gland loss, and metaplastic changes. There are two types: autoimmune metaplastic atrophic gastritis (AMAG) and environmental metaplastic atrophic gastritis (EMAG), which is commonly caused by Helicobacter pylori (H. pylori). Patients with atrophic gastritis are often asymptomatic or may only experience nonspecific discomfort in the epigastric region. Important diagnostic steps include gastroscopy with biopsy and laboratory studies (e.g., gastrin). The therapeutic approach depends on the underlying etiology. AMAG is treated with vitamin B12 substitution, whereas individuals with EMAG will receive H. pylori eradication therapy. If left untreated, atrophic gastritis may lead to peptic ulcer disease or result in the development of various cancers.

Epidemiological data refers to the US, unless otherwise specified.

Autoimmune metaplastic atrophic gastritis (AMAG)

Environmental metaplastic atrophic gastritis (EMAG)




General symptoms

Specific symptoms in AMAG

Specific symptoms in EMAG

Helicobacter-associated atrophic gastritis frequently manifests with ulcerations. Atrophic gastritis of autoimmune origin does not.

PPIs should be discontinued at least 2 weeks prior to testing for H. pylori to minimize false-negative rates. [7]

Microscopy findings

The following microscopic findings may be seen in both types of atrophic gastritis.

Patterns of affliction

The differential diagnoses listed here are not exhaustive.


Sucralfate should not be given simultaneously with PPIs and/or H2 antagonists because it is activated by an acidic environment.


  • Vitamin B12 replacement therapy (parenteral)
  • If H. pylori is detected: attempt to eradicate (may lead to healing)
  • Because there is a risk of malignant degeneration, regular endoscopic check-ups are required.

Helicobacter-associated atrophic gastritis



We list the most important complications. The selection is not exhaustive.

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