Atrophic gastritis is a common diagnosis in gastroscopy, because there is no complete cure for atrophic gastritis, in addition, atrophic gastritis is a pre-cancerous lesion of gastric cancer, there is a certain degree of malignant changes, so people are very concerned about what will be the manifestations of the aggravation of atrophic gastritis, how to determine the aggravation of atrophic gastritis? What are the symptoms of aggravation of atrophic gastritis? Clinical symptoms of atrophic gastritis lack specificity, some patients may not have obvious symptoms, most patients mainly show symptoms of dyspepsia, such as epigastric fullness, nausea and vomiting, epigastric pain, etc., and there may be epigastric burning sensation, acid reflux, belching, bitter taste in the mouth, bad breath and so on. Symptoms are usually relieved with medications that aid digestion, medications that suppress stomach acid, and medications that promote gastrointestinal motility. If atrophic gastritis is aggravated especially when malignant changes occur, firstly, the pain in the upper abdomen may be aggravated and persistent, which cannot be relieved by using medicines. Secondly, the symptoms of dyspepsia are aggravated, and there may be symptoms such as loss of appetite, emaciation, anemia, weakness, etc. In severe cases, patients may have nausea, vomiting, vomiting of blood, black stools and other symptoms. In particular, atrophic gastritis can cause internal factor deficiency, leading to malabsorption of vitamin B12 malnutrition anemia, so for unexplained malnutrition anemia, to consider atrophic gastritis aggravation. Although the clinical symptoms of atrophic gastritis are varied, there is no obvious correlation between the symptoms and the severity of the lesions, so whether atrophic gastritis is aggravated mainly depends on the pathological biopsy changes. According to the gastroscopic performance to determine the degree of atrophy atrophic gastritis in the endoscopic manifestation of the mucosa red and white, predominantly white phase, folds flattened or even disappeared, part of the mucosal blood vessels can be seen, may be accompanied by mucosal particles or nodular and other manifestations. Currently, the Kimura-Takemoto classification is commonly used in the clinical diagnosis of atrophic gastritis, in which those whose atrophy does not exceed the cardia are defined as type C, and those whose atrophy exceeds the cardia are defined as type O. The classification is based on the location and extent of the atrophy. According to the site and scope of atrophy, atrophic gastritis is categorized into low-risk C1, in which the atrophic limit is confined to the gastric antrum, medium-risk C2 and C3, in which the atrophic limit exceeds the gastric angle, and C3, in which the atrophic limit exceeds the gastric angle and is close to the cardia, and high-risk O1-3, in which O1 is the atrophic limit is just over the cardia, O2 is the atrophic limit has spread over the whole gastric fundus, and O3 is the atrophic limit extends into the body of the stomach. Therefore, according to the gastroscopy report, the severity of atrophic gastritis can be initially judged, that is to say, the larger the atrophic range, the more serious the condition is, that is, the atrophic degree of C1, C2, C3, O1, O2, O3 in order to increase. Judge the degree of atrophy according to pathological changes The diagnosis of atrophic gastritis needs to rely on the combination of endoscopy and pathology, as long as the pathological biopsy shows that the gastric mucosa intrinsic glands are atrophic, atrophic gastritis can be diagnosed, and endoscopic pathological biopsy is the gold standard for the diagnosis of atrophic gastritis at present. The degree of atrophy The essence of atrophic gastritis is actually the atrophy of the gastric mucosa inherent glands, the number is reduced, the function is reduced. Therefore pathologically atrophic gastritis is categorized as mild, moderate and severe. Mild refers to the reduction of the number of intrinsic glands by no more than 1/3 of the original glands, moderate refers to the reduction of the number of intrinsic glands between 1/3 and 2/3 of the original glands, and severe refers to the reduction of the number of intrinsic glands by more than 2/3, with only a few glands remaining, or even disappearing completely. If the pathologic report of mild atrophic gastritis becomes moderate or severe, it means that the atrophic gastritis has worsened. Degree of intestinal epithelialization The transformation of the gastric mucosal epithelium into epithelial tissue resembling the structure of the mucosa of the small or large intestine is called intestinal epithelialization. Intestinal epithelialization is an indicator of gastric mucosal damage and an important subtype of atrophic gastritis. The degree of enteroepithelialization is measured in terms of the extent of the lesion; mild is defined as an area of intestinal epithelialization that accounts for less than 1/3 of the total area of the gland and surface epithelium, moderate is defined as an area of intestinal epithelialization that accounts for 1/3 to 2/3 of the total area of the gland and surface epithelium, and severe is defined as an area of intestinal epithelialization that accounts for more than 2/3 of the total area of the gland and surface epithelium. Generally speaking, the higher the grade of intestinal epithelial hyperplasia, the larger the scope of the lesion, and the higher the rate of cancer Intraepithelial neoplasia versus heterogeneous hyperplasia Intraepithelial neoplasia and heterogeneous hyperplasia are in fact synonymous with each other, and both are the diagnostic names of precancerous lesions of epithelial tissues; however, heterogeneous hyperplasia focuses on the morphology changes, while intraepithelial neoplasia emphasizes more on the process of tumor evolution, and intraepithelial neoplasia is a bit more widely used for pathology nowadays. Heteroplasia is usually categorized into 3 grades: mild, moderate, and severe, and intraepithelial neoplasia is categorized into 2 grades: low-grade intraepithelial neoplasia and high-grade intraepithelial neoplasia, with high-grade intraepithelial neoplasia also encompassing early-stage or in situ carcinoma. Low-grade intraepithelial neoplasia in gastrointestinal tissues corresponds to mild and moderate xenodysplasia, and high-grade intraepithelial neoplasia corresponds to severe xenodysplasia. If the pathology report is severe heterogeneous hyperplasia or high-grade intraepithelial neoplasia, it indicates that atrophic gastritis is more serious and should be treated as early gastric cancer, with surgical treatment or endoscopic localization if necessary. Diagnostic value of gastric function test for atrophic gastritis Gastric function test is an important means of early screening for gastric cancer. It is performed by taking 2~5ml of human venous blood, determining the content of pepsinogen Ⅰ and Ⅱ (PGⅠ and Ⅱ), gastrin 17 (G-17), and antibody content of Helicobacter pylori (HP), and then analyzing them comprehensively so as to assist in judging the atrophy of the gastric mucosa. PGⅠ is negatively correlated with atrophic gastritis in the fundus and body of the stomach, and the lower the content of PGⅠ, the more severe the atrophy; PGⅡ has a higher correlation with fundus than sinus, and the content of PGⅡ is positively correlated with peptic ulcer, and the higher the content of PGⅡ, the higher the likelihood of peptic ulcer; Pepsin ratio (PGR) is the ratio of PGⅠ/PGⅡ, and the progressive decrease in PGR indicates the possibility of atrophy of the gastric mucosa. PGR is the ratio of PGⅠ/PGⅡ, when PGR decreases progressively, it means that the possibility of gastric mucosal atrophy is very high; G-17 can reflect the atrophy of gastric sinus mucosa, the lower the content of G-17, the more atrophy of the gastric sinus mucosa; HP antibody test can determine the HP infection of gastric body, related research shows that the positive rate of HP antibody of atrophic gastritis patients is higher than the rate of non-atrophic gastritis and the health of the population. Gastric function test is non-invasive, simple, reliable and inexpensive, which can be widely used for early screening of gastric cancer, and according to the test results, the severity of atrophic gastritis can be indirectly determined. Summary: Atrophic gastritis is a common disease, most of the prognosis is good, but some of them do develop cancer, so patients with atrophic gastritis should have regular review of gastroscopy and pathological biopsy, according to the clinical symptoms and endoscopic pathological biopsy report to determine whether atrophic gastritis is aggravated and whether there is a tendency to malignant changes, especially if there is a severe heterotropic hyperplasia or high-grade intraepithelial neoplasia, it should be actively treated. The patient should be treated aggressively.