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What Is Atrophic Gastritis?

Written by Dr. Michael Ruscio, DC on June 10, 2025

Written by Dr. Michael Ruscio, DC on June 10, 2025 — Reviewed by Kellie Blake

• What Is Atrophic Gastritis?|
• Symptoms|
• Causes|
• Risks|
• Diagnosis|
• Treatment|

Atrophic gastritis is chronic inflammation of the stomach lining—and it’s more common than you might think. Although some people don’t feel any symptoms at all, others may experience vague issues like fatigue, pale skin, or general upper belly discomfort that never quite goes away. 

Because the symptoms can be subtle, this condition often flies under the radar until it starts causing bigger problems, like low stomach acid, poor nutrient absorption, and eventually cancer.

The good news? If we catch it early, there’s a lot we can do to support healing and get you feeling better. In this article, I’ll walk you through what atrophic gastritis is, what might be causing it, and most importantly, how to treat it. 

What Is Atrophic Gastritis?

Gastritis simply means inflammation of the stomach. But when that inflammation sticks around for a long time and damages the stomach lining, it becomes what’s known as atrophic gastritis or chronic atrophic gastritis 1. Getting a proper diagnosis is important—not just to confirm atrophic gastritis, but to rule out other potential issues and figure out what’s causing the inflammation.

Most of the time, atrophic gastritis is driven by a common stomach infection. Other times, it’s triggered when the immune system attacks the stomach. 

One of the biggest problems it can lead to is low stomach acid (also called hypochlorhydria), which can cause all sorts of downstream issues like poor digestion and nutrient deficiencies. But worse than that, it can develop into cancer. 

Prevalence of Atrophic Gastritis

Atrophic gastritis is most common in people over the age of 50 and those infected with a gut bacterium called Helicobacter pylori. It occurs more frequently in Asia, where the prevalence is especially high. The condition carries a significant risk of complications, with up to 10% of affected people developing gastric cancer within five years 1. 

Common Symptoms of Atrophic Gastritis

Most people with atrophic gastritis don’t get symptoms 1, although one study found that almost a third of participants who had pain, bloating, or other symptoms in the upper gastrointestinal tract had atrophic gastritis 2. Those who do have signs or symptoms may notice 1

Anemia (common):

• Fatigue
• Weakness
• Headaches
• Heart palpitations
• Dizziness
• Irritability
• Depression
• Insomnia
• Mood swings

Digestive Symptoms (less common):

• Vague upper belly pain
• Nausea (can be short-lived and come and go)
• Occasional vomiting 

Physical Signs (rare and nonspecific):

• Pale skin
• Weight loss due to poor appetite
• Yellowing of skin or eyes (jaundice)
• Rapid heartbeat (tachycardia)
• Systolic heart murmur (extra sound the heart makes when it contracts to pump blood—heard with a stethoscope)

Atrophic Gastritis, Low Stomach Acid, and Nutrient Deficiencies

The chronic inflammation of atrophic gastritis wears down the stomach lining over time, damaging the parietal cells, which are responsible for making stomach acid 1. When parietal cells break down, your stomach can’t produce enough acid, which sets the stage for poor digestion and less nutrient absorption.

Chronic low gastric acid from atrophic gastritis may lead to the following 1:

• Vitamin B12 deficiency – The body needs B12 to make red blood cells and keep nerve cells healthy.
• Iron deficiency – The body needs iron to make healthy red blood cells.
• Folate deficiency – The body needs folate to make red blood cells.
• Loss of oxyntic mucosa – This part of the stomach lining makes acid and digestive enzymes.
• Loss of intrinsic factor – This stomach protein helps us absorb vitamin B12.
• Pernicious anemia – The body can’t absorb vitamin B12, causing low blood cell counts and symptoms like fatigue and weakness.
• Peptic ulcers – These sores in the stomach or upper intestine lining can cause pain and indigestion.

The damage done to the gut often results in some of the less overt symptoms of atrophic gastritis, such as fatigue and pale skin.

Atrophic Gastritis and Cancer

As if nutrient deficiencies and ulcers weren’t bad enough, untreated atrophic gastritis can quickly lead to these types of stomach cancer 1: 

• Gastric adenocarcinoma (gastric cancer) – This is the fifth most common cancer in the world—accounting for 26,890 of new U.S. cancer diagnoses in 2024—and it’s linked to H. pylori infection 3. 
• Type-1 gastric carcinoid – This stomach tumor can develop as a result of atrophic gastritis and pernicious anemia. It happens when high levels of a hormone called gastrin cause certain stomach cells (called enterochromaffin-like cells, which release histamine) to grow too much 4.

Since gastric cancer is one of the deadliest cancers worldwide—often detected too late—it’s important to find and monitor people with atrophic gastritis through regular endoscopy to catch changes early and reduce the need for major surgery. 

What Causes Atrophic Gastritis?

The most likely causes of atrophic gastritis relate to chronic inflammation from a combination of environmental and immune factors, including the following:

Helicobacter pylori Infection

Most cases of atrophic gastritis are caused by an H. pylori infection 1

H. pylori is a spiral-shaped bacterium that lives mostly in the stomach and infects about half the world’s population. It burrows into the stomach lining and causes inflammation, which damages the cells that make stomach acid. This can lead to low acid levels and the loss of important glands in the stomach lining.

Autoimmune Atrophic Gastritis 

Although most cases of gastritis are caused by an H. pylori infection, others can be caused by stomach autoimmunity 1. 

In autoimmune atrophic gastritis (AAG), the immune system wrongly attacks the stomach lining, causing inflammation that damages the cells and glands of the stomach 5. Some healthcare providers may call this condition autoimmune metaplastic atrophic gastritis (AMAG) or simply autoimmune gastritis (AIG).  

Risks Associated With Atrophic Gastritis

Atrophic gastritis can be related to other issues besides cancer. For example, people with atrophic gastritis are more likely to have other conditions, including 1:

• Hypothyroidism: Low thyroid activity slows the body’s metabolism.
• Myelodysplastic syndromes: Bone marrow can’t make enough healthy blood cells.
• Sideroblastic anemia: The body has iron but can’t use it properly to make red blood cells.
• Iron deficiency anemia: The body doesn’t have enough iron and red blood cells at the same time.
• Thalassemia: This inherited blood disorder causes the body to make abnormal hemoglobin, leading to anemia.

Diagnosing Atrophic Gastritis

Because atrophic gastritis often doesn’t cause symptoms early on, people don’t usually get diagnosed until many years later, when their symptoms are more severe 6. The following list outlines the ideal steps to getting diagnosed if you suspect atrophic gastritis 1:

1. Blood Tests: Blood tests check pepsinogen, gastrin-17, and H. pylori to screen for atrophic gastritis and decide if endoscopy is needed.
2. Endoscopy: A camera examines the stomach lining, and biopsies are taken from multiple areas to look for damage or abnormal growths.
3. Advanced Imaging: Special tools like chromoendoscopy or narrowband imaging help detect early signs of cancer during endoscopy.
4. Tissue Analysis: Biopsy samples are checked for cell damage or precancerous changes and used to assess your cancer risk.
5. Follow-Up: High-risk patients need repeat endoscopies, while low-risk cases are monitored based on shared decisions with their doctor.
6. H. pylori Treatment: H. pylori should always be treated to reduce future stomach cancer risk, even after abnormal cells are removed.

Treatment Options for Atrophic Gastritis

Current treatments for atrophic gastritis focus on getting rid of an H. pylori infection (if present), reducing inflammation, boosting dietary nutrients, and getting regular check-ups. A typical treatment plan for atrophic gastritis may include the following 1:

• Antibiotics for H. pylori: If you have an H. pylori infection, killing it can heal stomach lining damage and may lower the risk of stomach cancer, especially after early cancer has been removed.
• NSAIDs and Aspirin: These may slightly slow the progression of stomach damage after H. pylori is treated, but the benefit is small and not strong enough for routine use.
• Herbal/Other Drugs: Some studies suggest herbal treatments like Moluodan and drugs like Rebamipide may help reduce inflammation and cell damage, but more research is needed.
• Vitamins A, C, and E: Eating a diet rich in (or taking low doses of) these vitamins may lower stomach cancer risk by about one-third in the general population.
• Regular check-ups with endoscopy help monitor for worsening changes. If precancer or early cancer is found, it can often be removed with special techniques that don’t involve major surgery.

Dietary Changes

Diet is not a direct cause of atrophic gastritis, but certain dietary habits may aggravate an inflamed gastric lining in some people. For example, in one observational (survey) study, people with chronic gastritis reported that eating too fast, irregular mealtimes, and eating leftovers, sweets, spicy food, or meat contributed to their symptoms 7. 

Each person will have different responses to different foods, so if you’re having symptoms, recording them and what you eat can help you decide what foods you may want to avoid. A food and symptom log may also help a doctor diagnose you and figure out the root cause of your illness. 

An elimination diet based on the Paleo diet is often a good starting point to discover which, if any, foods contribute to your symptoms of atrophic gastritis. For example, the Paleo diet eliminates many common food triggers and allergens, including gluten and dairy. 

Here’s how we get our clients started with an elimination diet:

1. Consider whether any foods aggravate your symptoms, and eliminate these right away. 
2. Begin a 3–4 week elimination period during which you avoid common trigger foods. I recommend starting with a Paleo diet framework in most cases.  
3. If this helps to resolve symptoms, begin a reintroduction period in which you add one eliminated item back into your diet at a time (every 2–3 days), monitoring your symptoms. This should help you to identify which foods you should continue to avoid and which ones you can tolerate. Try not to reintroduce ultra-processed or sugary foods; otherwise, eat them only occasionally.
4. If the elimination period doesn’t help to resolve symptoms, consider a trial of a more specialized diet, such as a low FODMAP diet, to see if other common trigger foods may be adding to your gut distress.

Addressing Malabsorption

As atrophic gastritis advances, the stomach lining is damaged and replaced by intestinal-like cells, causing a loss of stomach acid and intrinsic factor. This leads to vitamin B12 deficiency and, sometimes—especially in younger patients—iron deficiency and anemia 8. Atrophic gastritis is also associated with deficiencies in folate, vitamin C, vitamin D, and calcium 8.

Depending on the cause of your atrophic gastritis, some supplements and a nutrient-rich diet may help address malabsorption and the symptoms it can cause.

B12 and Iron

B12 deficiency leads to a wide range of health problems, including anemia, nerve damage, and a higher risk of blood clots.

Supplementing with B12 and iron may help resolve vitamin B12 deficiency and prevent anemia and neurological issues that often come with atrophic gastritis 6. 

High oral doses of 500–1,000 micrograms/day or intramuscular cobalamin (B12 shots) can help with gastric atrophy. It’s common to start with more frequent treatment, such as every other day, eventually transitioning to weekly and then monthly, for life 5.

Though supplements are still necessary, it’s also important to get B12 and iron from your diet. 

Some foods rich in B12 include beef liver, clams, oysters, nutritional yeast, salmon, tuna, and beef 9. 

Some foods high in iron include fortified breakfast cereals, oysters, white beans, beef liver, lentils, spinach, and tofu 10.

Folate

A meta-analysis found that taking folic acid (20–30 mg per day for 3–6 months) may help improve or even reverse precancerous conditions like atrophic gastritis and intestinal metaplasia 11.

Another meta-analysis found that taking folic acid along with standard treatment for H. pylori-related chronic atrophic gastritis can make the treatment work better and help heal the stomach lining more effectively than standard treatment alone 12.

It’s especially good to eat foods with a lot of folate, such as beef liver, spinach, black-eyed peas, fortified breakfast cereals, white rice, asparagus, and Brussels sprouts 13.

Vitamin C

Vitamin C has the potential to improve stomach health by reducing inflammation and cell damage 14.

Foods high in vitamin C include sweet red and green peppers, oranges, grapefruits, kiwifruits, broccoli, strawberries, and Brussels sprouts 15.

Vitamin D and Calcium

Although autoimmune atrophic gastritis isn’t thought to reduce vitamin D levels 16, this important immune system nutrient may be especially low in people with AAG 17. Having enough vitamin D may help reduce inflammation, support immune balance, and prevent bone problems—in fact, we need vitamin D to absorb dietary calcium 16.

The sunshine vitamin—so-called because we get most of our vitamin D from the sun touching our skin—also tends to be low in people with an H. pylori infection, but supplementing with vitamin D can improve the eradication rate of H. pylori 18.

Although most of our vitamin D comes from exposing the skin to sunlight, we can get significant amounts from consuming trout, salmon, mushrooms that have been exposed to UV light, fortified milk (from animals or plants), and fortified breakfast cereals 19.

Calcium-rich foods include yogurt, mozzarella, sardines canned with bones, milk, tofu, soybeans, fortified breakfast cereals, and spinach 20.

Probiotics and H. pylori Treatment

Most cases of atrophic gastritis arise from an H. pylori infection in the stomach, so it’s worth talking about probiotics. When paired with standard antibiotic treatments, probiotics can really help get rid of an H. pylori infection and reduce the side effects of treatment. 

For example, three meta-analyses have shown that adding probiotics—whether Bifidobacterium, Lactobacillus, or Saccharomyces boulardii—to standard H. pylori treatment can improve eradication rates and significantly reduce side effects like nausea, diarrhea, and stomach discomfort 21 22 23.

Our Triple Therapy Probiotic Powder Sticks contain all of those types of probiotics—plus soil-based species—to give broad-spectrum benefits.

Knowing the Cause and Customizing Treatment

If you are diagnosed with atrophic gastritis, it’s important to discover the root cause, whether it’s an H. pylori infection or stomach autoimmunity. Addressing any other issues, such as anemia or micronutrient deficiencies, and decreasing your risk of gastric cancer will be essential. 

If you would like more personalized guidance on your path to healing, request my Gut Reset Guide or schedule an appointment at the Ruscio Clinic.

The Ruscio Institute has developed a range of high-quality formulations to help our clients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you. The information on DrRuscio.com is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.