AIG remains relatively uncommon on a global scale, with epidemiological studies suggesting a prevalence ranging from approximately 0.5% to 4.5% in the general population. A considerable diagnostic gap persists, as the true number of undiagnosed or misdiagnosed AIG cases is still unclear, partly due to non‑specific symptomatology in early stages. This underscores the critical importance of mastering its endoscopic recognition. The ability to accurately identify characteristic endoscopic features is therefore paramount, serving as a cornerstone for enhancing diagnostic detection rates, enabling timely intervention, and improving long‑term patient management strategies.

This study analyzed data from 149 patients diagnosed with AIG at two medical centers between January 2022 and June 2025. Clinical and endoscopic records were reviewed. The study involved a meticulous review of all available clinical records, laboratory data, and, most importantly, detailed endoscopic documentation (Table 1). A standardized endoscopic protocol was employed for all subjects: each patient underwent high‑definition gastroscopy. The primary aim of this methodological approach was to systematically identify, document, and analyze the key endoscopic markers pathognomonic or highly suggestive of AIG.

The demographic profile of the studied cohort revealed a mean patient age of 59.9 years, with a marked female predominance, as women constituted 73.5% of the group. Diagnosis was primarily based on endoscopic evaluation. Common reasons for referral included refractory iron deficiency anemia and previously diagnosed neuroendocrine tumors (NET). Typical endoscopic findings comprised "reverse atrophy" (97.3% of cases), dense mucus (89.2%), and remnants of oxyntic mucosa (53.7%). Additional observations were: white globe appearance (53.0%), glomus-like lesions (53.6%), type 1 NET (38.2%), size less than 5 mm lesions (57.9%), gastric adenocarcinoma (4.0%), and adenomas (4.0%)

The study highlights key clinical and endoscopic features that facilitate accurate diagnosis of AIG, including in outpatient settings. The integration of advanced imaging modalities allows precise detection of small, early‑stage type 1 NET, thereby enabling proactive management. The documented spectrum of findings—from benign inflammatory patterns to pre‑neoplastic and neoplastic lesions—directly contributes to a more nuanced and individualized oncologic risk stratification for patients with AIG. This, in turn, provides a solid evidence base to guide subsequent therapeutic decisions, surveillance intervals, and patient counseling. The ongoing prospective accumulation and analysis of clinical cases within this dedicated cohort are anticipated to further enhance diagnostic precision, validate the observed patterns, and potentially uncover new correlations, ultimately refining the standard of care for this condition.