eMedicine Specialties > Gastroenterology > Stomach

Gastritis, Atrophic: Follow-up

Author: Sandeep Mukherjee, MB, BCh, MPH, FRCPC, Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center
Coauthor(s): Antonia R Sepulveda, MD, PhD, Associate Professor of Pathology, University of Pennsylvania School of Medicine; Director of Surgical Pathology, Director of Surgical Pathology Fellowship, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania
Contributor Information and Disclosures

Updated: Jan 3, 2010

Follow-up

Further Outpatient Care

  • Guidelines for follow-up care for cases of atrophic gastritis are not established.
  • If the patient was treated for H pylori infection, confirm eradication. Perform evaluation of eradication at least 4 weeks after the end of treatment. Eradication may be assessed by noninvasive methods, such as the urea breath test.
  • Follow-up care may be individualized depending on findings during endoscopy. For example, if dysplasia is found at endoscopy, increased surveillance is necessary.

Deterrence/Prevention

  • Epidemiologic studies of H pylori- associated chronic gastritis show that acquisition of the infection is associated with large crowded households and lower socioeconomic status.
  • Well-defined measures to prevent infection are not established.

Complications

  • The multifocal atrophic gastritis that develops in some individuals with H pylori infection is associated with increased risk of the following:
    • Gastric ulcers
    • Gastric adenocarcinoma
  • The corpus-restricted atrophic gastritis that develops in patients with autoimmune gastritis is associated with an increased risk of the following:
    • Pernicious anemia
    • Gastric polyps
    • Gastric adenocarcinoma

Prognosis

  • Atrophic gastritis is a progressive condition with increasing loss of gastric glands and replacement by foci of intestinal metaplasia over years.
  • Results from studies evaluating the evolution of atrophic gastritis after eradication of H pylori have been conflicting. Follow-up for up to several years after H pylori eradication has not shown regression of gastric atrophy in most studies, while other studies report improvement in the extent of atrophy.
  • Whether H pylori eradication in a patient with atrophic gastritis reduces the risk of development of gastric cancer is another important question.
    • Available data are limited, but a prospective study in a Japanese population reported that H pylori eradication in patients with endoscopically-resected early gastric cancer resulted in decreased appearance of new early cancers, while intestinal-type gastric cancers developed in the control group without H pylori eradication.
    • These findings support an interventional approach, with eradication of H pylori if the organisms are detected in patients with atrophic gastritis, aiming at prevention of development of gastric cancer.

Patient Education

 


More on Gastritis, Atrophic

Overview: Gastritis, Atrophic
Differential Diagnoses & Workup: Gastritis, Atrophic
Treatment & Medication: Gastritis, Atrophic
Follow-up: Gastritis, Atrophic
Multimedia: Gastritis, Atrophic
References
Further Reading
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References

  1. Yanaoka K, Oka M, Ohata H, et al. Eradication of Helicobacter pylori prevents cancer development in subjects with mild gastric atrophy identified by serum pepsinogen levels. Int J Cancer. Dec 1 2009;125(11):2697-703. [Medline].

  2. Weck MN, Gao L, Brenner H. Helicobacter pylori infection and chronic atrophic gastritis: associations according to severity of disease. Epidemiology. Jul 2009;20(4):569-74. [Medline].

  3. Tahara T, Shibata T, Wang FY, et al. Mannan-binding lectin B allele is associated with a risk of developing more severe gastric mucosal atrophy in Helicobacter pylori-infected Japanese patients. Eur J Gastroenterol Hepatol. Jul 2009;21(7):781-6. [Medline].

  4. Gao L, Weck MN, Nieters A, Brenner H. Inverse association between a pro-inflammatory genetic profile and Helicobacter pylori seropositivity among patients with chronic atrophic gastritis: Enhanced elimination of the infection during disease progression?. Eur J Cancer. May 7 2009;[Medline].

  5. Gao L, Weck MN, Stegmaier C, Rothenbacher D, Brenner H. Alcohol consumption and chronic atrophic gastritis: Population-based study among 9,444 older adults from Germany. Int J Cancer. Jun 2 2009;[Medline].

  6. Palladino M, Chiusolo P, Reddiconto G, et al. MTHFR polymorphisms involved in vitamin B12 deficiency associated with atrophic gastritis. Biochem Genet. Oct 2009;47(9-10):645-50. [Medline].

  7. Lahner E, Norman GL, Severi C, et al. Reassessment of intrinsic factor and parietal cell autoantibodies in atrophic gastritis with respect to cobalamin deficiency. Am J Gastroenterol. Aug 2009;104(8):2071-9. [Medline].

  8. Stummvoll GH, DiPaolo RJ, Huter EN, et al. Th1, Th2, and Th17 effector T cell-induced autoimmune gastritis differs in pathological pattern and in susceptibility to suppression by regulatory T cells. J Immunol. Aug 1 2008;181(3):1908-16. [Medline].

  9. Huter EN, Stummvoll GH, DiPaolo RJ, Glass DD, Shevach EM. Pre-differentiated Th1 and Th17 effector T cells in autoimmune gastritis: Ag-specific regulatory T cells are more potent suppressors than polyclonal regulatory T cells. Int Immunopharmacol. May 2009;9(5):540-5. [Medline].

  10. Capella C, Fiocca R, Cornaggia M. Autoimmune gastritis. In: Graham DY, Genta RM, Dixon MF, eds. Gastritis. Philadelphia, Pa: Lippincott Williams; 1999:79-96.

  11. Correa P. Human gastric carcinogenesis: a multistep and multifactorial process-- First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res. Dec 15 1992;52(24):6735-40. [Medline].

  12. Dixon MF, Genta RM, Yardley JH. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. Oct 1996;20(10):1161-81. [Medline].

  13. Dore MP, Leandro G, Realdi G, Sepulveda AR, Graham DY. Effect of pretreatment antibiotic resistance to metronidazole and clarithromycin on outcome of Helicobacter pylori therapy: a meta-analytical approach. Dig Dis Sci. Jan 2000;45(1):68-76. [Medline].

  14. Franceschi F, Genta RM, Sepulveda AR. Gastric mucosa: long-term outcome after cure of Helicobacter pylori infection. J Gastroenterol. 2002;37 Suppl 13:17-23. [Medline].

  15. Gao L, Weck MN, Raum E, et al. Sibship size, Helicobacter pylori infection and chronic atrophic gastritis: a population-based study among 9444 older adults from Germany. Int J Epidemiol. Jul 13 2009;epub ahead of print. [Medline].

  16. Graham DY. Therapy of Helicobacter pylori: current status and issues. Gastroenterology. Feb 2000;118(2 Suppl 1):S2-8. [Medline].

  17. Graham DY, Belson G, Abudayyeh S, et al. Twice daily (mid-day and evening) quadruple therapy for H. pylori infection in the United States. Dig Liver Dis. Jun 2004;36(6):384-7. [Medline].

  18. Hershko C, Hoffbrand AV, Keret D, et al. Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia. Haematologica. May 2005;90(5):585-95. [Medline].

  19. Inoue T, Uedo N, Ishihara R, et al. Autofluorescence imaging videoendoscopy in the diagnosis of chronic atrophic fundal gastritis. J Gastroenterol. Oct 30 2009;epub ahead of print. [Medline].

  20. Konturek PC, Konturek SJ, Brzozowski T. Helicobacter pylori infection in gastric cancerogenesis. J Physiol Pharmacol. Sep 2009;60(3):3-21. [Medline].

  21. Krasinskas AM, Abraham SC, Metz DC, et al. Oxyntic mucosa pseudopolyps: a presentation of atrophic autoimmune gastritis. Am J Surg Pathol. Feb 2003;27(2):236-41. [Medline].

  22. Laiyemo AO, Kamangar F, Marcus PM, et al. Atrophic gastritis and the risk of incident colorectal cancer. Cancer Causes Control. Oct 17 2009;epub ahead of print. [Medline].

  23. Leung WK, Kim JJ, Kim JG. Microsatellite instability in gastric intestinal metaplasia in patients with and without gastric cancer. Am J Pathol. Feb 2000;156(2):537-43. [Medline].

  24. Malfertheiner P, Megraud F, O'Morain C, et al. Current concepts in the management of Helicobacter pylori infection--the Maastricht 2-2000 Consensus Report. Aliment Pharmacol Ther. Feb 2002;16(2):167-80. [Medline].

  25. Rugge M, Genta RM. Staging and grading of chronic gastritis. Hum Pathol. Mar 2005;36(3):228-33. [Medline].

  26. Shin CM, Kim N, Lee HS, et al. Validation of diagnostic tests for Helicobacter pylori with regard to grade of atrophic gastritis and/or intestinal metaplasia. Helicobacter. Dec 2009;14(6):512-9. [Medline].

  27. Sipponen P, Harkonen M, Alanko A, et al. Diagnosis of atrophic gastritis from a serum sample. Clin Lab. 2002;48(9-10):505-15. [Medline].

  28. Vaananen H, Vauhkonen M, Helske T, et al. Non-endoscopic diagnosis of atrophic gastritis with a blood test. Correlation between gastric histology and serum levels of gastrin-17 and pepsinogen I: a multicentre study. Eur J Gastroenterol Hepatol. Aug 2003;15(8):885-91. [Medline].

  29. Whittingham S, Mackay IR. Autoimmune gastritis: historical antecedents, outstanding discoveries, and unresolved problems. Int Rev Immunol. Jan-Apr 2005;24(1-2):1-29. [Medline].

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Further Reading

Related eMedicine Topics

Clinical Trials
Clinical Guidelines

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Keywords

atrophic gastritis, chronic gastritis, autoimmune gastritis, Helicobacter pylori, H pylori, type A gastritis, diffuse corporal gastritis, pernicious anemia–associated gastritis, metaplastic gastritis, atrophic pangastritis, progressive intestinalizing pangastritis, environmental atrophic gastritis, multifocal atrophic gastritis, MAG

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Contributor Information and Disclosures

Author

Sandeep Mukherjee, MB, BCh, MPH, FRCPC, Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center
Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Antonia R Sepulveda, MD, PhD, Associate Professor of Pathology, University of Pennsylvania School of Medicine; Director of Surgical Pathology, Director of Surgical Pathology Fellowship, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania
Antonia R Sepulveda, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Cancer Society, American Gastroenterological Association, American Society for Investigative Pathology, College of American Pathologists, and United States and Canadian Academy of Pathology
Disclosure: Nothing to disclose.

Medical Editor

Gregory William Rutecki, MD, Associate Professor, Program Director, Department of Internal Medicine, Feinberg School of Medicine, Northwestern University
Gregory William Rutecki, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Nephrology, National Kidney Foundation, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Simmy Bank, MD, Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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