Update understanding on diagnosis and histopathological examination of atrophic gastritis: A review

Abstract

Chronic atrophic gastritis (CAG) is a complex syndrome in which long-term chronic inflammatory stimulation causes gland atrophy in the gastric mucosa, reducing the stomach's ability to secrete gastric juice and pepsin, and interfering with its normal physiological function. Multiple pathogenic factors contribute to CAG incidence, the most common being Helicobacter pylori infection and the immune reactions resulting from gastric autoimmunity. Furthermore, CAG has a broad spectrum of clinical manifestations, including gastroenterology and extra-intestinal symptoms and signs, such as hematology, neurology, and oncology. Therefore, the initial CAG evaluation should involve the examination of clinical and serological indicators, as well as diagnosis confirmation via gastroscopy and histopathology if necessary. Depending on the severity and scope of atrophy affecting the gastric mucosa, a histologic staging system (Operative Link for Gastritis Assessment or Operative Link on Gastritis intestinal metaplasia) could also be employed. Moreover, chronic gastritis has a higher risk of progressing to gastric cancer (GC). In this regard, early diagnosis, treatment, and regular testing could reduce the risk of GC in CAG patients. However, the optimal interval for endoscopic monitoring in CAG patients remains uncertain, and it should ideally be tailored based on individual risk evaluations and shared decision-making processes. Although there have been many reports on CAG, the precise etiology and histopathological features of the disease, as well as the diagnosis of CAG patients, are yet to be fully elucidated. Consequently, this review offers a detailed account of CAG, including its key clinical aspects, aiming to enhance the overall understanding of the disease.

Keywords: Atrophic gastritis; Helicobacter pylori infection; Autoimmune gastritis; Diagnosis; Operative link for gastritis assessment staging; Gastric cancer risk

Core Tip: Chronic atrophic gastritis (CAG) is a complex syndrome with multiple pathogenic factors, broad and non-specific clinical manifestations, and it is often seen as fragmented by each expert in their specific field of expertise, making diagnosis difficult and the exact histopathological features unclear. Therefore, this review used a thematic analysis approach, focusing on studies related to the diagnosis, histopathological examination, etiology, clinical manifestations, and management of CAG. Priority was given to recent studies (within the last 10 years) to ensure that the review reflects the most current understanding of CAG. To enhance the understanding and diagnostic ability of clinical doctors towards CAG.