by Jason Wasserman MD PhD FRCPC
April 25, 2024

Atrophic gastritis is a medical condition where inflammation causes the lining of the stomach to become thin and damaged over time. This thinning primarily affects the glands that produce stomach acid and digestive enzymes, reducing stomach function. This condition is significant because it can interfere with food digestion and nutrient absorption and may increase the risk of stomach cancer.

What are the symptoms of atrophic gastritis?

The symptoms of atrophic gastritis can vary but often include:

• Indigestion or discomfort in the upper abdomen.
• Nausea and occasional vomiting.
• A feeling of fullness after eating only a small amount of food.
• Loss of appetite.
• Weight loss.
• Fatigue.

What causes atrophic gastritis?

Several factors can cause atrophic gastritis:

• Autoimmune reactions: The body’s immune system mistakenly attacks the stomach lining, leading to the loss of acid-producing cells.
• Chronic bacterial infection: Long-term infection with bacteria such as Helicobacter pylori (H. pylori) can cause inflammation and eventually lead to the thinning of the stomach lining.
• Prolonged use of certain medications: Regular use of medications that reduce stomach acid, like proton pump inhibitors, or anti-inflammatory drugs, such as aspirin, can contribute to the development of atrophic gastritis.
• Environmental factors: Excessive alcohol consumption, smoking, and chronic stress are also potential contributors.

How is the diagnosis of atrophic gastritis typically made?

The diagnosis of atrophic gastritis is typically made through a combination of clinical evaluation, laboratory tests, and diagnostic procedures:

• Medical history and physical examination: The doctor will ask about symptoms, dietary habits, medication use, and any family history of gastrointestinal diseases. A physical exam can help identify any abdominal tenderness or other signs that might suggest stomach issues.
• Blood tests: These can check for anemia, which is common due to malabsorption of vitamin B12 in atrophic gastritis. Blood tests can also detect antibodies that might indicate an autoimmune cause or infection markers for Helicobacter pylori.
• Stool test: This is a noninvasive test for Helicobacter pylori infection or to check for the presence of blood in the stool, which can occur with gastritis.
• Upper gastrointestinal endoscopy: This is the most definitive test for diagnosing atrophic gastritis. During an endoscopy, a flexible tube with a camera (endoscope) is passed down the throat into the stomach. This allows the doctor to visually inspect the stomach lining and take small tissue samples (biopsies).
• Biopsy and histological examination: The tissue samples taken during endoscopy are examined under a microscope to look for the specific microscopic features of atrophic gastritis, such as atrophy, inflammation, ECL cell hyperplasia, and foveolar metaplasia (see below for more information).

What are the microscopic features of atrophic gastritis?

Under the microscope, atrophic gastritis displays several distinct features:

• Atrophy: Thinning of the stomach lining, with a significant reduction in the number and size of the glands.
• Inflammation: The presence of inflammatory cells in the stomach lining can further damage the tissue.
• ECL (enterochromaffin-like) cell hyperplasia: ECL cell hyperplasia is a noncancerous increase in the number of ECL cells, which are typically involved in regulating acid production by releasing hormones.
• Pseudopyloric metaplasia: Transformation of the normal glandular cells into those resembling the pyloric glands found in the deeper parts of the stomach. This type of metaplasia often occurs as a response to chronic injury.
• Intestinal metaplasia: Replacement of the normal gastric cells with intestinal-type cells, featuring characteristics typical of the intestine, such as the presence of goblet cells. Intestinal metaplasia is significant because it can increase the risk of developing stomach cancer.

About this article

Doctors wrote this article to help you read and understand your pathology report. Contact us with any questions about this article or your pathology report. Read this article for a more general introduction to the parts of a typical pathology report.

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Atlas of Pathology