Atrophic gastritis is seen as the result of long standing Helicobacter pylori infection and recent studies have shown that circulating IgG antibodies to CagA are associated with this condition. Gastric atrophy is also seen in patients with pernicious anaemia caused by an immunological derangement associated with parietal cell antibodies. Non-immunological causes of atrophic gastritis include chronic alcoholism, bile reflux, drugs, partial gastrectomy, chronic pancreatitis, and liver cirrhosis. The clinical importance of gastric atrophy is that it significantly increases the risk for the development of gastric carcinoma. The prevalence of gastric atrophy is very variable but it can be detected in up to 25% of patients referred for upper gastrointestinal endoscopy. In the Sydney system of classification of gastritis a four grade scale is used: no atrophy and mild, moderate, or severe atrophy. Despite this, agreement among histopathologists for the recognition and grading of gastritis remains poor. The paper by Van Grieken et al in the January issue of this journal describes a new stereological method (point counting technique) for grading gastric atrophy in body type mucosa by an interactive image analysis system (QPRODIT).¹ Using an updated Sydney system of …