Atrophic gastritis is a reduction of intrinsic gastric glands or intestinal epithelial hyperplasia, but clinically many primary care hospitals also misdiagnose the reduction of glands due to superficial inflammation of the mucosa or intestinal epithelial hyperplasia in the small gastric recess area as atrophic gastritis. Therefore, a professional doctor must make a correct judgment whether it is a true atrophic gastritis or not. Atrophic gastritis is a precancerous lesion, which means that some of these lesions may develop into gastric cancer if left untreated. However, this is not common, and most people do not develop cancer throughout their lives. Even if a small number of people develop cancer, it is a long process. Many elderly people develop atrophic changes in the stomach. Patients who have had erosive gastritis or ulcers in the past may also develop intestinal epithelial hyperplasia when the lesions heal, meaning that the mucosa of the intestine grows over the stomach. Therefore, patients diagnosed with atrophic gastritis need not be alarmed, the key is to see how much this atrophy is related to cancer. Which atrophic gastritis is associated with cancer? In the past it was to look at the type of intestinal epithelial chemosis, because the so-called colonic type chemosis or incomplete intestinal chemosis is prone to heterotypic hyperplasia. This is because heterogeneous hyperplasia is the real precancerous lesion. Only moderate to severe heterogeneous hyperplasia requires high alert, such as severe heterogeneous hyperplasia (now also called high-grade intraepithelial neoplasia), which needs to be treated immediately. Mild heterogeneous hyperplasia or atypical hyperplasia requires only a review with endoscopy after 1-2 years. Therefore, it is important that patients diagnosed with atrophic gastritis be evaluated by an experienced physician. Atrophic gastritis presenting with severe heterogeneous hyperplasia can be removed endoscopically directly at the same time as gastroscopy, without the need for surgery or chemotherapy. Therefore, the development of atrophic gastritis to gastric cancer can be prevented because it can be managed endoscopically when cancerous lesions develop before they occur. At least there is insufficient evidence whether taking medication can prevent cancer. Therefore, long-term medication is not recommended for atrophic gastritis if there are no symptoms, because even if the lesion progresses to cancer, it can be easily detected by endoscopic follow-up and can be treated immediately. Therefore, whether atrophic gastritis is a real atrophic gastritis or whether atrophic gastritis is carcinogenic, it is best to get a proper evaluation from a professional doctor who really understands pathology and endoscopy and clinical practice. Endoscopic detection of atrophic gastritis requires an experienced pathologist to assess its cancer potential. Example: Atrophic gastritis with obvious heterogeneous hyperplasia of the gland on pathological biopsy requires endoscopic excision of the lesion to prevent the development of gastric cancer. Comment: Atrophic gastritis is generally an age-related change, and it is not necessarily cancerous, and even if it is, it is a chronic process. It can be completely cured. Pathological biopsy is very important to detect signs of cancer, so it is better to see an experienced doctor to evaluate the cancer potential first. Suggestion: If you have atrophic gastritis or intestinal epithelial metaplasia, you can upload the endoscopic and pathological examination images to see if cancer will occur.