To investigate the current status of compliance with endoscopic follow-up in patients with chronic atrophic gastritis (CAG) and analyze its influencing factors.

Clinical data of 1 196 patients with gastroscopy-diagnosed CAG in our department from May 1 to July 31, 2022 were retrospectively collected in this study. According to the status of gastroscopy reexamination in this hospital and other hospitals within the subsequent nearly 3 years, they were divided into a compliant group (n=473) and a non-compliant group (n=723). General demographic data of, and past medical history, including positive history of Helicobacter pylori (H.pylori) infection, intestinal metaplasia, and atrophy classification, as well as disease cognition of CAG, hospital distance, and medical background were collected during follow-up. The current status of compliance with endoscopic follow-up surveillance was analyzed. Univariate and logistic regression analyses were used to evaluate the independent influencing factors for patient compliance with gastroscopy reexamination, while receiver operating characteristic (ROC) curve and area under the curve (AUC) were adopted to determine the predictive efficiency of the logistic regression model on patient compliance with endoscopic follow-up monitoring.

Despite being advised by attending physicians to undergo reexamination within 2~3 years after CAG diagnosis, only 473 (39.55%) patients complied with the follow-up recommendation, while 723 (60.45%) patients did not. Univariate analysis showed statistical differences were observed between the 2 groups in terms of residence, education level, monthly income, history of coronary heart disease, symptoms, H. pylori infection history, intestinal metaplasia history, atrophy grade, disease cognition, health awareness score, initial department of visit, hospital distance, and medical background (all P<0.05). Logistic regression analysis revealed that the factors associated with higher compliance included having disease cognition (OR=6.280, 95%CI: 4.442~8.878, P<0.01), higher health awareness score (OR=2.219, 95%CI: 1.943~2.535, P<0.01), presence of symptoms (OR=2.537, 95%CI: 1.822~3.531, P<0.01), history of H. pylori infection (OR=2.159, 95%CI: 1.496~3.116, P<0.01), history of intestinal metaplasia (OR=3.452, 95%CI: 2.100~5.675, P<0.01), history of coronary heart disease (OR=2.306, 95%CI: 1.325~4.015, P<0.01), monthly income of 5 000~10 000 Yuan (OR=2.525, 95%CI: 1.693~3.766, P<0.01) or ≥10 000 Yuan (OR=4.268, 95%CI: 2.472~7.370, P<0.01) (both higher than those with monthly income<5 000 Yuan), type O atrophy (OR=2.523, 95%CI: 1.319~4.827, P<0.01) (higher than type C atrophy), and initial visit to gastroenterological department (OR=1.988, 95%CI: 1.345~2.939, P<0.01) (higher than visits to other departments). Conversely, longer hospital distance was associated with lower compliance (OR=0.981, 95%CI: 0.963~0.998, P<0.05). The patients with college or higher education level (OR=0.250, 95%CI: 0.138~0.453, P<0.01) had lower compliance than those with primary school education level or below, and those with medical background had lower compliance than those without (OR=0.289, 95%CI: 0.150~0.557, P<0.01).

Compliance with endoscopic follow-up surveillance in CAG patients is associated with disease cognition of CAG, health awareness score, monthly income, symptoms, H. pylori infection history, intestinal metaplasia history, atrophy grade, initial department of visit, history of coronary heart disease, hospital distance, and education level. Clinicians should formulate targeted individualized interventions to improve patient compliance and early warning for gastric cancer.