Multiple gastric biopsy was carried out upon one hundred and eleven patients over the age of forty years who were under investigation for dyspeptic symptoms. The overall incidence of atrophic gastritis was 64 %, being highest in those with gastric cancer and lowest in those with duodenal ulceration. Intestinal metaplasia of the gastric mucosa was found only in those with atrophic gastritis but was not confined to those with severe atrophic changes. No aspects of the clinical history or findings pointed to specific diagnostic features, but a significantly high incidence of gastric cancer was found in the family history of those with atrophic gastritis.

The haematological status of the subjects was studied, and a significantly high incidence of anaemia, but not of iron deficiency, was found among those with atrophic gastritis. Low serum Vitamin B12 levels were found in 8 %, and parietal cell antibodies in 17% of those with atrophic gastritis, and in none with normal mucosa, while the incidence of thyroid antibodies was higher in those with atrophic changes, but not significantly so. An increase in the incidence of blood group A was found in those with atrophic gastritis when compared with those with normal mucosa and with a comparable contrast group.

The intramuscular pentagastrin test was evaluated by comparison with other tests of gastric secretion, and when employed in the patients under study was found to discriminate between those with atrophic and those with normal mucosa with an accuracy of 81 %. The value of radiology, gastroscopy and blind gastric photography in the recognition of atrophic gastritis was studied. Discrimination between atrophic and normal gastric mucosa was accurate in 68% by barium meal examination, 65% by gastroscopy and 53% by gastric photography.

The historical aspects of atrophic gastritis have been reviewed as has the evidence for the various theories as to the aetiology of the condition. The association between atrophic gastritis and the anaemias, its relationship to gastric cancer, and its significance as a disease entity have been discussed, and a fourfold rationale for the importance of recognising the condition have been advanced in the light of these associations.

Gastric emptying rates were studied using a radioactive labelled meal and were found to be significantly slower in subjects with atrophic gastritis and with gastric cancer when compared with a healthy contrast group of subjects. The significance of this finding has been discussed.

The value and reliability of the clinical and haematological investigations in the detection of atrophic gastritis have been discussed, and an overall diagnostic accuracy of 89% with a false - positive incidence of 3% found, when the combined results were analysed.