**4. Conclusions**

The term ABG was used in the present article to designate cases of chronic gastritis with selective glandular atrophy of the mucosa of the stomach body while the antral mucosa continued to show a normal aspect or only minimal inflammatory changes. Extensive areas of intestinal metaplasia, pseudoantral metaplasia and endocrine cell hyperplasia often occur in the atrophic mucosa of the body. Taken together, these changes of the gastric mucosa strongly suggest the presence of an inflammatory process of autoimmune etiology accompanied or not by pernicious anemia of subclinical or even clinical evolution. Thus, the major importance of the histologic diagnosis of ABG resides in the fact that, for many dyspeptic patients submitted to upper digestive endoscopy this may be the first opportunity they have to receive a correct diagnosis of their main disease.

The histologic diagnosis of glandular atrophy of the stomach of mild or moderate grade is highly subjective and depends on many factors linked to tissue collection and processing. From an endoscopic viewpoint, the diagnostic imprecision is even greater. However, the more extreme grades of atrophy of the gastric mucosa are easy to interpret histologically when tissue samples are collected, processed and interpreted in an appropriate manner. When this is not the case, the histologic diagnosis of ABG is frequently inconclusive or equivocal. In the present study, out of 230 cases with an inconclusive histological diagnosis reviewed by an expert pathologist in the gastrointestinal area, 55 (24%) were confirmed as ABG, many of them after new histologic sections were obtained from paraffin blocks. Although in the cases studied the degree of gastric atrophy was intense and circumscribed to the body, the standard endoscopic exam showed a very low correlation with the histological findings. This fact associated with problems regarding tissue collection and processing impairs a conclusive diagnosis of ABG in many cases, with a consequent delay in the diagnosis of the principal disease of a patient who seeks a service of digestive endoscopy due to nonspecific dyspeptic complaints. However, new endoscopic techniques show a clear progress that promises to reverse the current secondary role of endoscopy in combination with histology for the evaluation of patients with different degrees of gastric mucosa atrophy and consequently with chronic gastritis of autoimmune etiology.
