Your pathology report for dysplasia in the stomach

By Jason Wasserman MD PhD FRCPC
November 2, 2025

Dysplasia in the stomach (also called gastric dysplasia or glandular intraepithelial neoplasia) is a precancerous change that affects the inner lining of the stomach. In dysplasia, the cells that normally cover the stomach wall begin to look and behave abnormally, but they have not yet spread into deeper layers of the stomach.

Dysplasia can stay stable for years, but in some people, it can turn into a type of stomach cancer called adenocarcinoma if it is not treated or monitored.

Where in the stomach does dysplasia start?

Dysplasia begins in epithelial cells, which are the cells that form the thin inner lining of the stomach. These cells normally make up glands, small pockets in the stomach wall that produce mucus and digestive juices. When these cells divide too quickly or develop genetic damage—changes in their DNA—they can become disorganized and start to show abnormal features. These early abnormal changes are referred to as dysplasia by pathologists.

Where in the stomach is dysplasia most often found?

Dysplasia can occur anywhere in the stomach, but it is most commonly found in the antrum, the lower portion of the stomach near its connection to the small intestine.

What causes dysplasia in the stomach?

Dysplasia typically develops gradually as a result of prolonged inflammation or irritation of the stomach lining.

Common causes include:

• Chronic infection with Helicobacter pylori, a type of bacteria that causes long-lasting inflammation in the stomach.

• Smoking or heavy alcohol use both damage the stomach’s protective lining.

• Epstein–Barr virus (EBV) infection, which can interfere with how cells grow and repair themselves.

• Genetic changes in important control genes such as CDH1 or APC. These genes regulate how cells grow, divide, and stick together. Mutations in these genes can occur by chance or, less commonly, be inherited.

Individuals with chronic atrophic gastritis (long-term inflammation accompanied by thinning of the stomach lining) or intestinal metaplasia (replacement of the normal stomach lining with intestinal-type cells) are also at a higher risk of developing dysplasia.

What are the symptoms?

Dysplasia in the stomach typically causes no symptoms on its own. When symptoms are present, they are usually due to the underlying inflammation or infection that caused them.

Common symptoms include:

• Persistent upper abdominal discomfort or pain.

• Bloating or indigestion after eating.

• Nausea or decreased appetite.

• Fatigue caused by anemia, which is a low red blood cell count, can occur if small ulcers bleed slowly over time.

Because dysplasia is microscopic, it is typically detected during an endoscopy performed for other stomach issues, such as gastritis or reflux.

Is dysplasia in the stomach the same as cancer?

No. Dysplasia is not cancer, but it is a precancerous condition. This means that the abnormal cells are still limited to the surface lining and have not invaded deeper tissues or spread to other organs.

Without treatment, especially in high grade dysplasia, there is a significant risk that the abnormal cells could eventually become stomach cancer. Detecting and treating dysplasia early prevents this from happening.

How is dysplasia in the stomach diagnosed?

The diagnosis of dysplasia is made after a biopsy of the stomach lining is examined by a pathologist, a doctor who specializes in diagnosing disease by studying tissue under the microscope.

The process leading to a biopsy typically begins when a patient has symptoms, a history of chronic gastritis, or an abnormal result from another test. Your doctor will perform a gastroscopy, also known as an upper endoscopy, to visually inspect the inner surface of the stomach and take small samples for testing.

Clinical examination and preparation

Before the procedure, your doctor will review your symptoms, medical history, and any relevant risk factors, such as a long-term Helicobacter pylori infection, smoking, or a history of previous stomach ulcers. You may be asked to fast for several hours so that your stomach is empty during the exam. A local numbing spray or mild sedative is usually given to make the procedure more comfortable.

Upper endoscopy and biopsy

During an upper endoscopy, the doctor gently passes a thin, flexible tube equipped with a camera (called an endoscope) through your mouth, down your throat, and into your stomach. This allows them to view the stomach lining on a screen in real time.

If the doctor sees any areas that look irregular—such as redness, small bumps, or patches of discoloured tissue—they will remove several tiny pieces of tissue, called biopsies, using special instruments passed through the endoscope. These samples are placed in a solution that preserves the tissue and are sent to a pathology laboratory for analysis.

The procedure usually takes 10 to 20 minutes, and patients can go home shortly afterward. Mild throat soreness or bloating may occur temporarily but typically resolves within a day.

Examination by a pathologist

A pathologist then examines the biopsy under a microscope to look for abnormal changes in the cells that line the stomach. Dysplasia is diagnosed when the glandular cells show abnormal nuclei (the dark central part of the cell that contains genetic material), crowding, and irregular growth patterns.

The pathologist also notes the level of mitotic activity, which indicates how actively the cells are dividing, and whether the cells are forming organized glands or disorganized clusters. These findings are used to determine whether the dysplasia is low grade or high grade.

How is dysplasia in the stomach graded?

Pathologists divide dysplasia into two grades—low grade and high grade—based on how abnormal the cells look and how fast they are dividing.

Low grade dysplasia

In low grade dysplasia, the cells appear only mildly abnormal. The nuclei (the cell centers that hold DNA) are slightly enlarged and darker but remain evenly arranged. The glands are still well-formed and maintain some of their normal structure. The mitotic activity (number of dividing cells) is low, meaning the cells are not dividing excessively.

The risk that low grade dysplasia will progress to stomach cancer is low (about 10% within one year). However, regular monitoring is essential to make sure it does not worsen.

High grade dysplasia

In high-grade dysplasia, the cells look very abnormal. The nuclei are irregular, darker, and often vary in size and shape. The glands become crowded and disorganized, with little normal connective tissue separating them. The mitotic activity is high, meaning many cells are dividing, and the pathologist may see atypical mitoses, which are abnormal forms of cell division.

High grade dysplasia has a much higher chance (up to 70% within one year if untreated) of developing into stomach cancer and is usually removed or treated immediately.

Types of dysplasia in the stomach

Pathologists describe two main types of dysplasia in the stomach based on the appearance of the abnormal cells under the microscope.

• Intestinal-type dysplasia is composed of cells that resemble the cells that normally line the small intestine. It is often linked to H. pylori infection and intestinal metaplasia.

• Foveolar-type dysplasia is made up of cells that look similar to normal stomach cells (called foveolar cells) but that are arranged abnormally or divide too quickly.

Both types are considered precancerous, and both can lead to stomach cancer over time if untreated. The distinction between them can only be made by a pathologist after examining a biopsy under the microscope.

What happens after diagnosis?

What happens next depends on the grade of dysplasia and whether the abnormal tissue has been completely removed.

• For low grade dysplasia, treatment often focuses on addressing the underlying cause, such as eradicating H. pylori infection and avoiding smoking and alcohol. Follow-up endoscopy is recommended within 6 to 12 months to monitor for any changes.

• For high grade dysplasia, the affected tissue is usually removed during an endoscopic procedure such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). If there are signs that cancer may have already developed, surgery may be required.

After treatment, patients undergo regular surveillance endoscopy to detect any recurrence or new areas of dysplasia.

Your pathology report guides these decisions by describing the type, grade, and completeness of removal of the dysplastic tissue.

Questions to ask your doctor

• What type and grade of dysplasia do I have?

• Was Helicobacter pylori infection detected in my biopsy?

• Has the dysplastic area been completely removed, or is more treatment needed?

• How often should I have follow-up endoscopy?

• What is my risk of developing stomach cancer?

• Should genetic testing be considered based on my results or family history?