The clinical manifestations of chronic atrophic gastritis not only lack specificity, but are not completely consistent with the extent of the lesion. Clinically, some patients with chronic atrophic gastritis may have no obvious symptoms. However, most patients may have burning pain, distension, dull pain or fullness, stuffiness in the upper abdomen, especially after eating, loss of appetite, nausea, belching, constipation or diarrhea. In severe cases, there may be emaciation, anemia, brittle nails, tongue inflammation or tongue papilla atrophy, and in a few cases of gastric mucosal erosion, there may be upper gastrointestinal bleeding. Among them, type A atrophic gastritis complicated by pernicious anemia is rare in China. The disease has no specific signs, and there may be mild pressure pain in the upper abdomen. Endoscopic manifestations of chronic atrophic gastritis: 1. The gastric mucosa becomes lighter in color: pale red, grayish yellow, or in severe cases, grayish white or grayish blue. It may be diffuse or may have a limited patchy distribution. The peripheral border is indistinct. It is the earliest manifestation of mucosal atrophy microscopically. 2, submucosal vascular penetration: mucosal atrophy makes submucosal vessels visible. Atrophy can be seen in the early stage of mucosa dark red reticulated small blood vessels, severe cases can be seen in the mucosa of blue dendritic larger veins. Vascular exposure is an important endoscopic feature of chronic atrophic gastritis. However, it should be noted that the gastric mucosa can be permeable to the vascular network when the gastric pressure is too high due to hyperinflation of the normal gastric fundus. 3, the mucosal folds are small or even disappear. When air is injected into the stomach, the folds disappear quickly, and after the air is removed, the folds recover more slowly, and the gastric secretions are less, sometimes the mucosa is dry and the reflection is weakened. 4, when chronic atrophic gastritis is accompanied by transitional hyperplasia of the glandular neck or intestinal epithelial hyperplasia, the mucosal surface is rough and uneven, granular or nodular, sometimes visible pseudo-polyps are formed, and the features of the submucosal vessels are often obscured. Although microscopic visual observation can initially determine intestinal epithelial metaplasia, the diagnosis must be confirmed by pathological examination of gastric mucosa. 5, atrophic mucosa increased brittleness, easy bleeding, and may have foci of erosion. 6, chronic atrophic gastritis can be accompanied by the manifestations of chronic superficial gastritis, such as congestion erythema, attached mucus, and enhanced reflection. If the changes of superficial gastritis are predominant, it is called superficial ? atrophic gastritis. If chronic atrophic gastritis changes are predominant, it is called atrophic superficial gastritis. The most important thing is to have a good understanding of the situation. X-ray examination lacks clear diagnostic significance for chronic atrophic gastritis. The majority of atrophic gastritis is not found abnormally on barium gastric X-ray. The gas-barium double imaging mostly shows reduced gastric tone, flattening and thinning of gastric mucosal folds, especially thinning or disappearance of serrated mucosal lines on the large curved side of the gastric body, smooth gastric base, and some gastric sinusitis gastric sinus mucosa may be serrated or coarse mucosal disorder. When chronic atrophic gastritis with intestinal epithelial chemosis into proliferative changes, the gastric mucosa can be uneven, the so-called “type IV gastric cell”. When the mucosa of chronic atrophic gastritis is highly atrophic, the mucosa is flat and smooth, the so-called gastric atrophy, its X-ray signs can be more obvious, mainly manifested as follows: 1, tubular stomach, in the standing position, the large and small curves of the stomach smooth, especially the large curved side is obvious, the edges of the large and small curves are almost parallel; 2, the gastric bubble becomes smaller, the large curved side and the bottom of the gastric folds disappear in a bald and flat shape; 3, the large curved side of the gastric folds can also be shallow 3, the lateral folds of the greater curvature of the stomach can also be shallow and serrated, which can easily disappear when the stomach is dilated; 4, the whole stomach is hypotonic.