Improvement in Chronic Atrophic Gastritis After Treatment with Zinc L-Carnosine

Objective: Unusual clinical course Background: Chronic atrophic gastritis (CAG) remains a recognized risk factor for gastric cancer, particularly when associated with intestinal metaplasia. Although Helicobacter pylori eradication is the cornerstone of CAG reversal, especially in halting progression from intestinal metaplasia to CAG, evidence for alternative therapeutic approaches remains limited. Recently, various agents have been proposed as effective and safe for these patients because of their detoxifying, antioxidant, anti-inflammatory, and reparative effects on gastric mucosal injury. Zinc L-carnosine, a chelate compound of zinc and L-carnosine soluble in acidic environments, has demonstrated high affinity for inflamed tissue and effectiveness in alleviating dyspeptic symptoms. Case Report: We report 2 cases of CAG - 1 secondary to autoimmune gastritis and the other secondary to H. pylori infection - that were managed with oral zinc L-carnosine 39.5 mg twice daily for at least 12 months due to persistent dyspeptic symptoms. Both patients underwent endoscopic and histologic reassessment at least 12 months after therapy initiation. Clinically significant improvement was observed not only in dyspeptic symptoms but also in histologic features of CAG. The beneficial effects of long-term zinc L-carnosine treatment were further supported by improved gastric function, as indicated by changes in pepsinogen I, pepsinogen II, and gastrin 17 levels. Conclusions: These case reports suggest that zinc L-carnosine can improve both dyspeptic symptoms and histologic features of CAG, thereby potentially reducing progression to gastric cancer. Larger clinical studies are warranted to confirm these findings.