Atrophic gastritis

Atrophic gastritis is a chronic condition of autoimmune and non-autoimmune etiology. 

Pathology

Two types of atrophic gastritis have been described ^1-3:

• type A: autoimmune
  • gastric body and fundus atrophy secondary to antiparietal cell antibodies
  • decreased secretion of acid and intrinsic factor, with the latter leading to vitamin B₁₂ deficiency
• type B: non-autoimmune (more common)
  • gastric antrum atrophy secondary to Helicobacter pylori infection (most common), alcohol, NSAIDs, or bile salt reflux

Associations

• vitamin B₁₂ deficiency ^1-3
  • pernicious anemia (megaloblastic)
  • subacute combined degeneration of the cord
• gastric carcinoid tumors ^4,5

Radiographic features

Fluoroscopy

Upper gastrointestinal fluoroscopic studies are non-specific but may demonstrate ^1,2:

• decreased/absent fundal folds ('bald fundus')
• narrow tubular stomach (fundal diameter <8 cm)
• small/absent areae gastricae

Treatment and prognosis

Patients with atrophic gastritis are three times more likely to develop gastric cancer ². 

Differential diagnosis

• linitis plastica: this is usually nodular ²