PERSPECTIVE article
Front. Immunol.
Sec. Mucosal Immunity
This article is part of the Research TopicGut microbiome and immune systemView all 6 articles
The Oral-Gut Axis in Chronic Atrophic Gastritis: Current Perspectives and Integrated Strategies
Provisionally accepted
- 1Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
- 2Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
- 3Jiangsu Province Hospital of TCM Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Chronic atrophic gastritis (CAG) is a key precursor to gastric cancer, characterized by progressive mucosal atrophy, inflammation, and microbial dysbiosis. The Correa cascade model highlights Helicobacter pylori as a primary driver, progressing from gastritis to atrophy, intestinal metaplasia (IM), dysplasia, and malignancy. However, 20%–30% of CAG cases lack H. pylori involvement, emphasizing the roles of non-H. pylori microbial dysbiosis, environmental factors, and the oral-gut axis in disease progression. Oral microbes, such as Porphyromonas gingivalis, translocate to the stomach, amplifying inflammation through NF-κB and Wnt/β-catenin pathways and altering metabolites like short-chain fatty acids and trimethylamine N-oxide. Pro-inflammatory cytokines, including IL-1β, IL-6, and IL-17, alongside Th17-driven immune dysregulation, further accelerate carcinogenesis. This perspective integrates multi-omics data to elucidate microbiome shifts, metabolic changes, and immune responses across CAG subtypes. Advanced diagnostics, such as endoscopic imaging, serum biomarkers, and oral microbiota profiling, enable precise risk stratification. Management strategies extend beyond H. pylori eradication to include probiotics, fecal microbiota transplantation, periodontal interventions, and herbal compounds, targeting the oral-gut axis to restore microbial balance and halt carcinogenesis. This framework offers novel avenues for prevention and therapy in high-burden regions.
Keywords: Chronic atrophic gastritis, Helicobacter pylori, Immune responses, Intestinalmetaplasia, Microbiome dysbiosis, oral-gut axis, precision management
Received: 05 Sep 2025; Accepted: 10 Dec 2025.
Copyright: © 2025 Zha, Ding, Xu, Zhang, Guo, Ge and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Tian Yue Zha
Jnwei Guo
Luzhou Xu
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