How Is Chronic Gastritis Diagnosed?

Chronic gastritis can be classified into two main types: non-atrophic and atrophic, based on endoscopic findings. The definitive diagnosis of chronic gastritis typically requires a gastroscopy, and in some cases, a biopsy is also necessary for accurate assessment. During a gastroscopy, non-atrophic gastritis may present with a mottled red and white mucosal appearance, predominantly red, and might be accompanied by symptoms such as erosion, bile reflux, or intestinal metaplasia.

In cases of non-atrophic gastritis, microscopic examination of the biopsy sample often reveals normal glandular structures with potential infiltration of neutrophils. This may occur alongside signs of acute inflammation. These histological features help distinguish it from other forms of gastric inflammation and guide further clinical management.

On the other hand, chronic atrophic gastritis presents differently under the endoscope, showing a more pale or whitish mucosa with visible submucosal vascular patterns. Biopsy results typically indicate a significant reduction in gastric glands, along with inflammatory cell infiltration—such as neutrophils or mononuclear cells—and possible intestinal metaplasia or dysplasia. Due to the increased risk of gastric cancer associated with chronic atrophic gastritis, regular follow-up is strongly recommended.

However, in elderly patients—especially those over 80 or even 90 years old—gastric atrophy may be part of natural aging processes. If there are no precancerous changes or high-risk features, frequent monitoring every three to six months may not be required. Instead, a more balanced and individualized approach to surveillance is advised, taking into account both the patient's overall health and the potential risks of the condition.