[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Gastrointestinal tract](https://durgical.com/en/general-pathology/areas/gi/) › Gastric atrophy, intestinal metaplasia and dysplasia

# Gastric atrophy, intestinal metaplasia and dysplasia

- Process

Years of gastritis can thin the stomach lining, turn it gut-like and then produce abnormal cells that come before cancer.

Updated Nov 12, 2026

## Key points

- Oxyntic atrophy plus intestinal metaplasia (goblet cells) strongly raises gastric cancer risk; risk is highest in autoimmune gastritis.
- Achlorhydria allows bacterial overgrowth and nitrosamine formation.
- Inflammation supplies free radicals and proliferative stimuli (regeneration, gastrin).
- Dysplasia: variation in size, shape and orientation, coarse hyperchromatic enlarged nuclei; unlike reactive change, it does not mature at the surface.
- Intestinal metaplasia can regress after H. pylori eradication.
- Gastritis cystica polyposa (submucosa) and profunda (deeper), often after partial gastrectomy.

## What it is

Chronic gastritis of any cause can follow a slow path: glands are lost (atrophy), the lining is replaced by intestinal-type epithelium (metaplasia), and genetic damage accumulates until the epithelium becomes dysplastic. This sequence, best known in H. pylori infection, precedes intestinal-type gastric adenocarcinoma. Gastritis cystica is a separate reactive lesion in which cysts are trapped in the wall and can mimic invasive cancer.

## Structure

- Atrophy: thin mucosa with few glands and loss of rugae.
- Intestinal metaplasia: goblet cells, absorptive cells and sometimes Paneth cells in gastric pits.
- Dysplasia: crowded, elongated or rounded hyperchromatic nuclei extending to the surface.
- Gastritis cystica: dilated epithelial-lined cysts in the submucosa or muscle with regenerative change.

## Step by step

- Chronic inflammation (H. pylori, autoimmunity) damages glands.
- Parietal and chief cells are lost: atrophy.
- Intestinal-type epithelium with goblet cells replaces gastric glands: metaplasia.
- Free radicals, regeneration and gastrin drive mutations: low-grade then high-grade dysplasia.
- Invasion through the basement membrane: intestinal-type adenocarcinoma.

## Clinical notes

- This sequence explains why gastric cancer is common where H. pylori is common, as in the Colombian Andes.
- Gastritis cystica profunda must not be mistaken for invasive carcinoma on biopsy.

## Memory aid

Gastritis, then thin, then gut-like, then wild: the four rooms before the cancer.

## Test yourself

Think of the answer, then tap the question to see it.

## What histologic finding defines intestinal metaplasia of the stomach?

Goblet cells (with absorptive and sometimes Paneth cells) replacing gastric epithelium.

## How does the pathologist distinguish dysplasia from reactive change?

Reactive epithelium matures as it reaches the surface; dysplastic epithelium stays immature and atypical to the surface.

## Why can gastritis cystica be mistaken for cancer?

Epithelial-lined cysts entrapped deep in the gastric wall, with regenerative atypia, look like invasion.

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## Connections

## Related 7

- [Helicobacter pylori gastritis](https://durgical.com/en/general-pathology/helicobacter-pylori-gastritis/)
- [Autoimmune atrophic gastritis](https://durgical.com/en/general-pathology/autoimmune-atrophic-gastritis/)
- [Gastric polyps](https://durgical.com/en/general-pathology/gastric-polyps/)
- [Gastric adenocarcinoma: intestinal vs diffuse](https://durgical.com/en/general-pathology/gastric-adenocarcinoma-intestinal-vs-diffuse/)
- [Metaplasia](https://durgical.com/en/general-pathology/metaplasia/)
- [Dysplasia and carcinoma in situ](https://durgical.com/en/general-pathology/dysplasia-and-carcinoma-in-situ/)
- [Precancerous conditions: when chronic inflammation, metaplasia or hyperplasia raise the risk](https://durgical.com/en/general-pathology/precancerous-conditions-when-chronic-inflammation-metaplasia-or-hyperplasia-rais/)

## Related conditions 3

- [Helicobacter pylori gastritis](https://durgical.com/en/conditions/helicobacter-pylori-gastritis/)
- [Gastric cancer](https://durgical.com/en/conditions/gastric-cancer/)
- [Pernicious anaemia](https://durgical.com/en/conditions/pernicious-anaemia/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Gastric Cancer](https://www.ncbi.nlm.nih.gov/books/NBK459142/) (StatPearls (NCBI Bookshelf), 2025); [Helicobacter Pylori](https://www.ncbi.nlm.nih.gov/books/NBK534233/) (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/gastric-atrophy-intestinal-metaplasia-and-dysplasia/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/gastric-atrophy-intestinal-metaplasia-and-dysplasia/