Chronic atrophic gastritis is a disease in which the epithelium of the gastric mucosa is repeatedly damaged, resulting in the atrophy and disappearance of the intrinsic glands of the mucosa. This patient will have upper abdominal fullness, discomfort or pain, more pronounced after meals, along with other indigestion symptoms such as belching, acid reflux, nausea, vomiting, and loss of appetite. Gastroscopy and pathological examination can confirm the diagnosis, with pathological findings as the gold standard for diagnosis. The pathological typing in chronic atrophic gastritis commonly involves glandular atrophy, intestinal epithelial hyperplasia and atypical hyperplasia (abnormal hyperplasia). The degree of lesions can be classified as mild, moderate or severe. Most data suggest that mild and moderate atrophy is reversible, while severe atrophy has little reversibility. Let’s understand intestinal epithelial metaplasia: normally, there is no intestinal epithelium in the gastric mucosa glands, and the more severe the atrophy, the more intestinal metaplasia appears. Some scholars have followed up patients with gastric mucosal intestinal lesions for 10 years, and the cancer rate is only 1.9%. Although the pathological study on the process of gastric cancer found that the cancerous cells are evolved from normal-aging-proliferating-atypical-proliferating-cancerous gastric mucosa cells, this process is long, not a year or two, so if you have chronic atrophic Therefore, if you have chronic atrophic gastritis, you should not be overly afraid that you are about to develop into gastric cancer. Mild atrophic gastritis is common in the elderly and does not require daily medication. It is a phenomenon of ageing, just like wrinkles on your face, and the chances of it becoming cancer are small. If you find atypical hyperplasia in the hospital, you should pay attention to it. First of all, you should ask the doctor to analyze again whether there may be a lesion but not biopsied (which is very common in clinical practice, not the doctor’s error), if so, you need to check the gastroscope again to take a biopsy. If a lesion is found, but it is difficult to see the lesion, staining + magnification endoscopy is needed. If cancer is suspected, ultrasound endoscopy is needed first to determine the depth of the lesion to see if treatment can be performed under endoscopy. We have various examination methods to confirm the diagnosis, and can also perform endoscopic cancer debridement. Moderate atypical hyperplasia is a precancerous condition and requires endoscopic management. For patients with chronic atrophic gastritis, gastroscopy should be reviewed regularly in order to monitor the dynamic changes of the lesion. The time of review is generally once every 3 years for atrophic gastritis; once every year for those with incomplete colonic enterosis or mild atypical hyperplasia; once every 3 months for those with moderate atypical hyperplasia (endoscopic debridement should be done if there is a clear lesion); for severe atypical hyperplasia, endoscopic debridement is also feasible if the lesion is found to be located in the mucosal layer after performing ultrasound endoscopy. When you see this, you will know that some atrophic gastritis may become a prelude to gastric cancer, but only a very small number of patients will be transformed into gastric cancer. Therefore, general patients do not need to be alarmed, and even if they have severe atrophic gastritis, they do not need to be nervous and pessimistic. As long as the patient is treated carefully and comprehensive therapy is adopted, the condition can be improved or cured. It should be reminded that while treating, various causative factors should be removed, such as quitting smoking and drinking, eating less pickled foods, avoiding overeating and eating spicy and moldy foods, paying attention to dietary hygiene, eating less and more meals, actively treating chronic diseases of the mouth and pharynx, etc. If such patients have H. pylori infection must be treated and eradicated.