Atrophic Gastritis: What It Is, Causes, and How It Is Detected

Seeing "atrophic gastritis" in a gastroscopy report is always a little unexpected. Let us calmly sort out what it means and how it is confirmed. To be clear from the start: the diagnosis is made by a doctor based on the results of gastroscopy and biopsy, not on a single word in the report.

What atrophic gastritis is

Atrophic gastritis is chronic gastritis in which the gastric mucosa thins, the number of glands in it decreases, and secretory capacity declines. The working cells of the mucosa are gradually replaced by others — secretory insufficiency of the stomach develops. This does not happen in a week: chronic gastritis can last for months and years.

Causes of gastric mucosal atrophy

The most common causes include Helicobacter pylori infection, anti-inflammatory painkillers such as aspirin, ibuprofen, and naproxen, excessive alcohol consumption, and gastric surgery.

Less often, the culprits are autoimmune disorders (including pernicious anemia), bile reflux into the stomach, viruses such as cytomegalovirus and herpes simplex, trauma, and severe illnesses — renal failure, major surgery, mechanical ventilation. Cocaine and caustic substances are mentioned separately.

Types: antral gastritis and intestinal metaplasia

Antral specifies the location — the antrum, the lower part of the stomach. If the report says atrophic gastroduodenitis, it means the duodenum is affected as well.

Intestinal metaplasia is a structural rearrangement: gastric cells begin to resemble intestinal cells. In about half of cases (50%), atrophic gastritis is combined with elements of structural rearrangement of the mucosa: intestinal, pyloric, villous, or pancreatic metaplasia, dysplasia, or epithelial neoplasia. This is what is seen in a biopsy specimen under the microscope, not a verdict from a single word.

Symptoms and acidity

Many people with gastritis have no symptoms at all. If they do appear, they include pain in the upper abdomen, dyspepsia, a feeling of fullness and bloating, nausea, vomiting, and decreased appetite.

• pain or discomfort in the upper abdomen
• fullness and bloating after eating
• nausea and vomiting
• decreased appetite

The link with reduced acidity is direct: atrophy means a decrease in the number of glands and secretory insufficiency of the stomach — less acid is produced.

How it is diagnosed: gastroscopy and biopsy

Diagnosis of atrophic gastritis begins with examination of the mucosa. One of the examinations is esophagogastroduodenoscopy (EGDS): the doctor examines the stomach with an endoscope and takes a biopsy from suspicious areas. A biopsy allows the condition of the mucosa to be assessed under a microscope.

At the same time, the cause is sought: a breath test for Helicobacter pylori (a special solution, then a breath check), a stool test for the bacterium or occult blood, and a complete blood count for anemia. After that, the decision is up to the gastroenterologist.

Complications and when to see a doctor

If ignored, gastritis can progress and lead to gastric ulcer. Possible consequences include blood loss and an increased risk of stomach cancer; the prognosis depends on the cause but is often very good.

You should see a gastroenterologist if pain or dyspepsia lasts longer than a week or if the pain intensifies and returns. Loss of appetite, fullness after a very small portion, recent unintentional weight loss, a feeling of a lump in the abdomen, pain or difficulty swallowing, and persistent vomiting require prompt evaluation.

A report of "atrophic gastritis" on its own is not a reason to call an ambulance. 103 or 112 are needed if vomiting of bright red blood or coffee-ground material begins, the stool becomes black, sticky, and very foul-smelling, or severe pain in the abdomen or chest appears suddenly.

This material is for reference: it does not replace a doctor's consultation, and a gastroscopy report is best discussed with a gastroenterologist in person.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer