Chronic Atrophic Gastritis: A Review

Chronic atrophic gastritis is a generally asymptomatic condition of great importance because it develops into gastric cancer in a number of patients. It is described as an atrophy of the gastric mucosa. There are two types of atrophic gastritis: a gastric body predominant type in patients with infection of Helicobacter pylori, and an autoimmune type, limited to the gastric body and fundus. The autoimmune type is quite rare and affects people of all ethnicities. Globally, H. pylori infection is very common and is considered a class I carcinogen due to the large number of patients who subsequently develop gastric cancer. The pathogenesis of the autoimmune type involves an antibody-mediated loss of parietal cells resulting in achlorhydria and an antibody-mediated loss of intrinsic factor that causes pernicious anemia. The diagnosis of H. pylori infection is based on endoscopy and culture of the organisms. Patients with atrophic gastritis as well as H. pylori infection should be treated with antibiotics to eradicate the organism. Patients with the autoimmune type need to be evaluated for anemia, and if present, treated with vitamin B12.