Atrophic Gastritis: How Serious Is It?

Atrophic gastritis is a chronic condition that affects the stomach lining, leading to the thinning of the gastric mucosa and reduced function. The severity of atrophic gastritis depends on several factors including the extent of atrophy, histological changes, presence of intestinal metaplasia, and whether dysplasia (abnormal cell growth) is present.

Understanding the Classification of Atrophic Gastritis

The OLGA (Operative Link for Gastritis Assessment) staging system is commonly used to classify the severity and spread of atrophic gastritis. If the atrophy is limited to the antrum (lower part of the stomach), it is categorized as stage C1, where "C" stands for closed-type atrophy. These cases are generally considered mild and localized. As the stages progress from C1 to C3 and then to O1–O3 (open-type atrophy), the affected area expands beyond the antrum to involve the corpus (upper part of the stomach), indicating more advanced disease.

How Pathological Changes Influence Severity

Beyond anatomical spread, the degree of cellular changes observed under a microscope also determines how serious the condition is. Moderate to severe atrophy combined with intestinal metaplasia significantly increases the risk of gastric cancer, potentially reaching up to 5% in some cases. Patients with widespread or severe atrophy along with intestinal metaplasia should undergo regular endoscopic surveillance to monitor for precancerous or cancerous developments.

The Role of Dysplasia in Gastric Cancer Risk

When atrophic gastritis is accompanied by dysplasia—especially high-grade dysplasia—it is classified as a precancerous lesion. In such cases, endoscopic interventions like endoscopic mucosal resection (EMR) or radiofrequency ablation may be recommended to remove abnormal tissue and prevent progression to cancer. Timely treatment can lead to complete remission in many patients.

In summary, while not all cases of atrophic gastritis are life-threatening, it's essential to assess each case individually based on histological findings, extent of atrophy, and presence of dysplastic changes. Regular follow-up through gastroscopy and close monitoring by a gastroenterologist are crucial, especially for those with advanced stages or high-risk features. Early detection and management can significantly reduce the risk of complications, including gastric cancer.