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This review synthesizes current knowledge on the pathophysiology, diagnosis, and management of AIG, with a special focus on familial aggregation, polyglandular autoimmunity, and emerging therapeutic strategies. We discuss the diagnostic challenges posed by serological variability, the complex interplay with Helicobacter pylori infection, and the diagnostic pitfalls of macrocytic anemia. Furthermore, we explore precision risk stratification models for gastric neuroendocrine tumors (gNETs) and gastric adenocarcinoma, emphasizing the roles of endoscopic surveillance and molecular biomarkers. Finally, we review emerging therapeutic options, including novel immunomodulators and microbiome-targeted interventions. This review provides a comprehensive framework for clinicians to navigate the complexities of AIG, from early diagnosis to long-term management, with the goal of improving patient outcomes and mitigating the risk of malignant transformation.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1878128","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T05:48:53Z","timestamp":1781243333000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Autoimmune gastritis: a comprehensive review of pathophysiology, risk stratification, and management"],"prefix":"10.3389","volume":"17","author":[{"given":"Minxiao","family":"Feng","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine","place":["Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenting","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine","place":["Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Third Affiliated Hospital of Zhejiang Chinese Medical University","place":["Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2025.10.015","article-title":"Autoimmune gastritis: Diagnosis, clinical management and natural history. 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