Chronic atrophic gastritis (CAG) is a well-established precursor of intestinal gastric cancer. However, data on incidence of CAG are rare, especially from population-based studies. The aim of this analysis was to estimate the incidence of CAG in a large population-based study among older adults from Germany and to identify major risk factors associated with its development. In the baseline and 5-year follow-up examinations of the ESTHER study, serological measurements of pepsinogen (PG) I and II and Helicobacter pylori antibodies were performed in 5,229 women and men, aged 50-74 years at baseline. Information on additional potential risk factors was obtained by questionnaire. CAG was defined by PGI < 70 ng/mL and PGI/PGII < 3. In total, there were 58 (1.1%) incident CAG cases. CAG incidence increased with increasing age from 0.5% in age group 50-54 years to 2.1% in age group 70-74 years. Seropositivity with H. pylori was strongly associated with CAG incidence, with adjusted odds ratios of 5.0 [95% confidence interval (CI): 1.6-15.8] and 11.3 (95% CI: 4.2-30.0) for participants with cytotoxin associated gene A (cagA) negative and cagA positive H. pylori infection at both baseline and follow-up compared to those without H. pylori infection, respectively. Gender, education, smoking, alcohol consumption and family history of gastric cancer were not significantly associated with CAG incidence. Incidence of CAG is rather low in the German population. Older age and infection with H. pylori are key risk factors for the development of CAG.With 700,000 deaths per year worldwide, gastric cancer remains the second leading cause of cancer deaths worldwide, despite a major decline in incidence and mortality in the past decades. 1 Chronic atrophic gastritis (CAG) is an essential precursor lesion in the development of intestinal type of gastric cancer. 2,3 It is widely accepted that gastric carcinogenesis is a continuous process leading via glandular atrophy and metaplasia/dysplasia to adenocarcinoma, and it is assumed that most gastric cancer cases have had preceding atrophy. 4,5 However, very little is known about incidence rates of CAG as most studies on this lesion have been cross-sectional. 6 The few existing longitudinal studies reported incidences ranging from 0 to 11% per year. However, they mostly included selected study populations, the majority of which consisted of patients with a variety of gastric disorders. [7][8][9][10][11][12][13][14] In the population-based gastroscopy studies by Correa et al. 15 and Vorobjova et al. 16 conducted in high risk populations of Columbia and Estonia, incidence of CAG was reported to be 7.1% per year (in the gastric corpus and antrum simultaneously) and 1.9% per year (in the gastric corpus), respectively. In two other population-based studies from Japan, 17,18 in which different pepsinogen-based definitions were used to define CAG, annual CAG incidences were reported to be 2.7% and 1.3%, respectively.Infection with Helicobacter pylori is known to be a major risk factor for the devel...
