The diagnosis of atrophic gastritis can be confirmed by gastroscopy and histopathological biopsy, but the pathological findings are the gold standard for diagnosis. Pathologic staging in chronic atrophic gastritis commonly involves glandular atrophy, intestinal epithelial metaplasia (referred to as enteroplasia), and epithelial neoplasia (heterogeneous or atypical hyperplasia). The degree of lesions can be classified as mild, moderate or severe. Most data show that mild and moderate atrophy is reversible, and mild atrophic gastritis is common in the elderly and does not require daily medication, just like wrinkles on the face, which is mostly an ageing phenomenon, while severe atrophy is very reversible. The heavier the atrophy the more intestinalization appears, removing the cause plus treating the intestinalization can disappear, so you have intestinalization is not too nervous, some scholars on the gastric mucosa intestinalization of the patient follow-up survey 10 years, the cancer rate is only 1.9%. First of all, we should ask the doctor to analyze whether there may be a lesion but not biopsied (very common in clinical practice, not the doctor’s error), if so, we 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 and to see if treatment can be performed under endoscopy (e.g. cancer debulking). Moderate epithelioma-like lesions are precancerous and require endoscopic intervention. In patients with chronic atrophic gastritis, gastroscopy should be reviewed regularly in order to monitor the dynamics of the lesions. The time of gastroscopy review is generally once every 3 years for atrophic gastritis, once every year for incomplete colonic enterosis or mild epithelioma-like lesions, and once every 3-6 months for moderate epithelioma-like lesions (endoscopic debridement should be done if there is a clear lesion), and endoscopic debridement is also feasible for severe epithelioma-like lesions found to be located in the mucosal layer after 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 them are transformed into gastric cancer. Therefore, there is generally no need to be alarmed, and even with severe atrophic gastritis, there is no need to be nervous and pessimistic. As long as the patient is treated carefully, regular follow-up gastroscopy and comprehensive therapy are 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.