Repeated or persistent HP infections and poor dietary habits are potential factors that aggravate gastric mucosal atrophy and intestinalization. Excessive nitrate and nitrite in soil and water, imbalance of trace elements, smoking, chronic alcohol consumption, lack of fresh vegetables and fruits and essential nutrients, frequent consumption of fast foods such as moldy, pickled, smoked and fried foods, excessive salt intake, and family history of gastric cancer can increase the risk of chronic atrophic gastritis or aggravate chronic atrophic gastritis and even increase the possibility of cancer. Chronic atrophic gastritis is often combined with intestinalization, and in a few cases, intraepithelial neoplasia, which can develop into gastric cancer in a few cases after a long period of evolution. Most of the low-grade intraepithelial neoplasia is reversible and less likely to become malignant gastric cancer. Chronic atrophic gastritis, especially those with moderate to severe intestinal or intraepithelial neoplasia, should be followed up with regular endoscopy and pathological histological examination. It is generally accepted that moderate to severe chronic atrophic gastritis has a certain cancer rate. In order to reduce the incidence of gastric cancer and to facilitate patients and meet the requirements of medical economics, chronic atrophic gastritis with moderate or severe atrophy and intestinalization on biopsy should be followed up about once a year, while chronic atrophic gastritis without intestinalization or intraepithelial neoplasia can be followed up with endoscopy and pathology as appropriate. Those with low-grade intraepithelial neoplasia and proof that the specimen is not from a paracancerous source should be followed up once every 6 months or so depending on the endoscopic and clinical situation, while high-grade intraepithelial neoplasia must be confirmed immediately and endoscopic treatment or surgery should be performed after confirmation.