Mechanism of Chronic Atrophic Gastritis: A 20-Year Bibliometric Analyses

Introduction

Chronic atrophic gastritis (CAG), characterized by the loss of gastric glandular structures and replacement by intestinal-type epithelium or fibrous tissue, represents a critical precancerous stage in the Correa cascade of gastric carcinogenesis.¹ With a global prevalence of approximately 20–30% in high-risk populations, CAG is closely associated with Helicobacter pylori infection, autoimmune mechanisms, and environmental factors, contributing to significant morbidity and mortality due to its progression to gastric cancer.^2,3 Over the past two decades, advances in molecular biology, genomics, and clinical diagnostics have deepened our understanding of CAG’s pathogenesis, including dysregulated immune responses, oxidative stress, and epigenetic alterations.^4,5 However, despite extensive research, the heterogeneity of CAG mechanisms, challenges in early diagnosis, and gaps in targeted therapies remain unresolved.⁶

Bibliometric analysis, a quantitative tool for evaluating scientific literature, has emerged as a powerful method to map research trends, identify knowledge gaps, and forecast future directions in medical fields.⁷ Previous bibliometric studies have illuminated evolving paradigms in hepatology, such as treatment of liver fibrosis and mechanism of liver regeneration research,^8,9 yet a comprehensive analysis focusing on the mechanism of CAG is lacking. This gap hinders a systematic synthesis of interdisciplinary contributions, geographic collaboration patterns, and translational research priorities in CAG.

Despite two decades of research into its pathogenesis, the vast body of literature has not yet been systematically mapped. A comprehensive bibliometric analysis mapping the field’s evolution, collaborative networks, and knowledge gaps remains lacking. Therefore, a 20-year bibliometric analysis (2005–2024) to delineate the intellectual landscape of research on the mechanism of CAG research is about to be conducted. By analyzing publication trends, influential authors, institutions, and keyword clusters, we aim to (1) identify seminal works and emerging themes, (2) evaluate global collaboration networks, and (3) highlight translational challenges and opportunities. Our findings will provide researchers, clinicians, and policymakers with actionable insights to optimize resource allocation and foster innovation in CAG management.

Materials and Methods

Data Selection

Relevant data were retrieved on January 14th, 2025 from the most influential database, the Web of Science Core Collection (WoSCC). The retrieval time span was from January 1st, 2005 to December 31st, 2024. The language was limited to English, and the article type was restricted to Articles or Reviews. Using Boolean logic operators, search terms such as “the mechanism of chronic atrophic gastritis” OR “the mechanism of chronic gastritis” OR “the mechanism of atrophic gastritis” were employed. The results were selected in the form of “Full Record and Cited References” and downloaded in the “Plain Text” document format. Subsequently, as the file format “download_*.txt” was only recognized by CiteSpace, the downloaded files were renamed accordingly. Additionally, ethical approval was not required for this study since the data were directly retrieved and exported from the WoSCC database.

Data Analysis and Visualization

Nowadays, widely used bibliometric software includes CiteSpace, VOSviewer, UCINET, SciMAT, Pajek, and Bicomb.¹⁰ However, there is no consensus on which software is superior. Taking into account their unique features and aligning with our practical requirements, CiteSpace [version 6.3.R1 (64-bit)] and VOSviewer (version 1.6.20) were selected for bibliometric analysis in this study.^11,12

CiteSpace, a citation visualization software based on Java and developed by Professor Chaomei Chen, also serves as a bibliometric analysis tool. It can identify potential research hotspots and trends within a specific field by generating knowledge-maps.¹³ In this study, the annual growth trend of publication outputs, countries/regions and institutions, journals and co-cited journals, authors and co-cited authors, the occurrence of keywords, co-cited references, and reference bursts were analyzed and visualized to understand the mechanism of CAG.

VOSviewer, a bibliometric mapping software developed by Leiden University and based on Java, excels in visualizing scientific knowledge and managing large bibliometric maps derived from network data.¹² Utilizing bibliographic and text data, the software analyzes and visualizes productive journals and authors, relevant knowledge maps, keyword research, and cluster maps, serving as a complement to the capabilities of CiteSpace software.

Methods

We employed CiteSpace (v6.3.R1) and VOSviewer (v1.6.20) for bibliometric analysis and visualization.

CiteSpace was used to analyze publication trends, collaboration networks, keyword bursts, and reference co-citation patterns. Parameters included: time slicing (2005–2024), node types (eg, country, institution, keyword), and pruning (pathfinder algorithm).

VOSviewer complemented this by mapping co-authorship, journal co-citation, and keyword co-occurrence networks. The minimum occurrence threshold for keywords was set to 5.

Microsoft Office Excel 2010 was used for data management and preliminary trend analysis.

All visualizations (eg, network maps, timeline views) were generated to highlight evolutionary trends and research hotspots in CAG mechanisms.

Results

Figure 1 depicts the flow chart of bibliographic retrieval and research steps undertaken in this study.

Figure 1 Flowchart of this study.

Annual Growth Trend of Publications

According to the criteria for data selection, a total of 954 papers on the mechanism of CAG were retrieved from WoSCC between 2005 and 2024 (Supplementary Material). These comprised 717 (75.16%) original articles and 237 (24.84%) reviews. As illustrated in Figure 2, the quantity of publications regarding the mechanism of CAG has been increasing steadily and progressively over the years.

Figure 2 Chronological trend of publications about the mechanism of chronic atrophic gastritis.

Productive Countries/Regions and Institutions

A total of 3259 institutions, originating from 177 countries/regions, collaboratively authored 954 research papers. Table 1 illustrated that CHINA led with the highest count of published outputs, totaling 396, which constituted 41.51% of the entire publications. The USA followed with 145 publications, representing 15.20%, while JAPAN had 86 (9.01%), ITALY 64 (6.71%), and SOUTH KOREA 62 (6.50%). From Table 1, it was evident that CHINA and the USA significantly outpaced other countries/regions in terms of publication numbers. Within the top 10 ones, solely CHINA and BRAZIL were categorized as developing countries. Moreover, the USA demonstrated a greater centrality with a score of 0.43, signifying its crucial role as a connector in international cooperation. Regarding the institutions, Chengdu University of Traditional Chinese Medicine and Vanderbilt University (n = 23, 2.41%) topped the list with the highest number of publications, succeeded by Chinese People’s Liberation Army General Hospital (n = 22, 2.31%), and Veterans Health Administration along with the US Department of Veterans Affairs (n = 20, 2.10%). Nevertheless, it was worth mentioning that among the top 10 institutions, all were from either CHINA or USA.

Table 1 The Top 10 Countries/Regions and Institutions Involved Studies on the Mechanism of Chronic Atrophic Gastritis

As shown in Figure 3A (countries/regions co-occurrence map), it illustrated a dense network of connections between nations, particularly highlighting numerous collaborations between CHINA and the USA. In Figure 3B (institutions co-occurrence map), the widespread distribution of yellow and light green years suggested that the period starting from 2018 had seen the most intense inter-institutional cooperation, with fewer such collaborations occurring prior to this time.

Figure 3 Co-occurrence maps (A) Countries; (B) Institutions). Notes: The size of node represents the co-occurrence frequencies while the links reflect the co-occurrence relationships. The color of node and line indicates different years.

Productive Journals and Co-Cited Journals

To examine the journals with the highest quantity of published articles and co-citations within the CAG mechanism, VOSviewer (version 1.6.20) and CiteSpace [version 6.3.R1 (64-bit)] were utilized for conducting analyses on co-citation and journals being co-cited. The statistical findings indicated that 954 documents were published across 430 academic journals. Table 2 listed the top 10 journals and co-cited journals related to the mechanism of CAG. Within these journals, WORLD J GASTROENTERO, with 1395 citing articles, was the most published, succeeded by GASTROENTEROLOGY (n = 1225), J ETHNOPHARMACOL (n = 735), CANCER LETT (n = 575), and HELICOBACTER (n = 467). Additionally, within the Q1 JCR (Journal Citation Reports) category, there were 9 journals, among which GASTROENTEROLOGY (IF = 25.7) boasted the highest impact factor (IF). From the entire list of journals, the top 300 with the strongest total link strength were selected to construct the overlay map (Figure 4A), which could effectively illustrate the productive journals based on the color timeline.

Table 2 The Top 10 Journals and Co-Cited Journals Associated with the Mechanism of Chronic Atrophic Gastritis

Figure 4 The density maps (A) Journals; (B) Co-cited journals). Notes: The size of word and round, and the opacity of yellow are positively associated with the co-cited frequency.

Regarding the journals most frequently cited in Table 2, GASTROENTEROLOGY (n = 629) topped the list, closely followed by GUT (n = 547), WORLD J GASTROENTERO (n = 459), HELICOBACTER (n = 403), and P NATL ACAD SCI USA (n = 362). Notably, all these journals occupied the Q1 region in the JCR, with NEW ENGL J MED boasting the highest IF of 96.2. The network diagram in Figure 4B adeptly showcased the top 200 co-cited journals, selected based on their strongest total link strength.

Productive Authors and Co-Cited Authors

The results of the bibliometric analysis conducted using VOSviewer (version 1.6.20) indicated that 5612 authors were retrieved. As presented in Table 3, Liu Yuetao ranked first with 16 published papers, followed by Zhao Yanling and Qin Xuemei (each with 14 papers), Wang Ruilin (11 papers), and Wei Shizhang (9 papers). Additionally, with the chosen threshold of a minimum of 2 documents per author, a total of 578 authors were ultimately selected to construct the network map. As illustrated in Figure 5A, various colors denoted different clusters, signifying close collaboration between clusters, such as those between Liu Yuetao and Zhao Yanling, Liu Yuetao and Hao Xinyu, Liu Yuetao and Cheng Chun, and so forth. Moreover, active collaborations related to the mechanism of CAG were readily observed, particularly among authors within the same cluster, including collaborations between Zhao Yanling and Wang Ruilin, Zhao Yanling and Li Haotian, Zhao Yanling and Wei Shizhang, among others.

Table 3 The Top 10 Authors and Co-Cited Authors Involved Studies on the Mechanism of Chronic Atrophic Gastritis

Figure 5 The co-occurrence maps in the mechanism of chronic atrophic gastritis (A) Authors; (B) Co-authors). Notes: The size of node indicates the author’s co-occurrence frequencies while its different colors reflect different clusters, and the links reflect the co-occurrence relationship between authors (Map A). The size of word and round, and the opacity of yellow are positively associated with the co-cited frequency (Map B).

Co-cited authors are those who are cited together in a range of papers. A total of 28,500 co-authors were identified. As shown in Table 3, the top 10 co-cited authors were all cited more than 90 times. The most frequently cited was CORREA P (n = 259), followed by MALFERTHEINER P (n = 159), YAMAOKA Y (n = 137), PEEK RM (n = 125), and BACKERT S (n = 121). Furthermore, authors with at least 20 co-citations (n = 236) were selected to create a density map, which effectively displayed the high-frequency co-cited authors through a gradient of yellow. From Figure 5B, it is evident that the yellow region corresponding to CORREA P was the darkest, indicating that this author was the most co-cited in the field.

Keyword Co-Occurrence, Clusters, and Evolution

VOSviewer (version 1.6.20) offered keyword co-occurrence and network cluster analysis. Utilizing this software, we extracted a total of 4609 keywords. Given the minimal impact of infrequently occurring keywords, we established a threshold of “minimum number of occurrences of a keyword ≧ 5” for selection. Consequently, 365 keywords met this threshold and were utilized for further analysis. As presented in Table 4, which listed the top 20 occurring keywords, these indicated the research hotspots of the CAG mechanism. Seven keywords appeared more than 100 times. By frequency, the keyword “Helicobacter pylori” topped the list with 372 occurrences, followed by “gastric cancer” (n = 176), “expression” (n = 162), “cancer” (n = 138), “infection” (n = 117), “chronic atrophic gastritis” (n = 113), “atrophic gastritis” (n = 106), “Helicobacter pylori infection” (n = 96), “intestinal metaplasia” (n = 87), and “inflammation” (n = 78). Additionally, these high-frequency keywords were visually represented in the density map (Figure 6A).

Table 4 The Top 20 Keywords Associated with the Mechanism of Chronic Atrophic Gastritis

Figure 6 Maps of keywords in the mechanism of chronic atrophic gastritis (A) The density map; (B) Co-occurrence network and clusters). Notes: The size of word and round, and the opacity of yellow are positively associated with the co-cited frequency (Map A). The size of node and keyword indicates the co-occurrence frequencies while their different colors reflect different clusters, and the links reflect the co-occurrence relationship (Map B).

Additionally, Figure 6B depicted the results of a network cluster analysis on keywords. In this map, 7 clusters represented 7 distinct research directions and scopes. Cluster 1, colored in red, is the largest, followed by cluster 2 (green), cluster 3 (blue), cluster 4 (yellow), cluster 5 (purple), cluster 6 (light blue), and cluster 7 (orange). Specifically, cluster 1 contained 83 items, including Helicobacter pylori eradication, CDX-2, COX-2, gastric intestinal metaplasia, NF-kappa B, and others. Cluster 2 had 69 items, such as acid-secretion, antibiotic resistance, duodenal ulcer, dyspepsia, and Helicobacter pylori infection. Cluster 3 included 68 items, such as Helicobacter pylori, autoimmune gastritis, chronic inflammation, cytokines, and immune-responses. Cluster 4 consisted of 62 items, including Helicobacter pylori, CAGA, colonization, beta-catenin signal, e-cadherin, and more. Cluster 5 had 59 items, encompassing anti-inflammation, antioxidant, apoptosis, metabolomics, and oxidative stress. Cluster 6 contained 22 items, such as Helicobacter pylori, body-mass index, Chinese medicine, gut microbiota, and leptin. Lastly, cluster 7 had just 2 items, which were China and epidemiology.

The Keywords Timeline Viewer, constructed by CiteSpace, clustered keywords while considering their temporal evolution, effectively displaying the trajectory of high-frequency terms within each cluster. Additionally, the viewer aided in identifying the timeline of specific topics and the developmental path of our research field. As depicted in Figure 7, the focus and evolution of the mechanism of CAG at each stage were visually apparent.

Figure 7 Keywords timeline viewer of the mechanism of chronic atrophic gastritis.

Citing Article and Co-Cited References

In order to identify the major citing article and the most co-cited references related to the mechanism of CAG, CiteSpace [version 6.3.R1 (64-bit)] was utilized for bibliometric analysis. As depicted in Table 5, the results of clustering all the included references revealed five relevant clusters: A. Traditional Chinese Medicine, B. Macrophage Biology, C. Gastric Intestinal Metaplasia, D. Changing Face, and E. Antioxidant Systems Vitamin C. Specifically, cluster A primarily described the mechanism of action of Chinese medicine compounds in the treatment of CAG. Cluster B mainly elucidated the pathological changes of gastric mucosa following Hp infection and its eradication from the perspective of macrophage biology. Cluster C primarily addressed the progression of gastric mucosal intestinal metaplasia and the current diagnosis and treatment strategies. Cluster D primarily interpreted the changing face of chronic autoimmune atrophic gastritis. Lastly, cluster E primarily detailed the role of the antioxidant system in the progression of gastric cancer.

Table 5 Summary of the Largest 5 Clusters Including Citing Articles and Cited References

Reference Burst

Reference bursts, characterized by frequent citation over a period of time, were detected using CiteSpace software. The selection criteria included a minimum burst duration of 2 years and the identification of the top 50 references with the strongest citation bursts. As shown in Figure 8, 14 references (28%) exhibited citation bursts in 2005, followed by 2017 and 2007, both with 5 references each, accounting for 10%. Furthermore, it was observed that 47 references, constituting 94%, experienced bursts until 2022. Regarding the strongest burst, a practice guideline titled “Management of Helicobacter pylori infection--the Maastricht IV/Florence Consensus Report,” with a burst strength of 11.79, was published in GUT by Malfertheiner Pet al in 2012.¹⁴ Additionally, its citation burst occurred from 2012 to 2022.

Figure 8 View Citation Burst History. Notes: The blue bars mean the reference had been published; The red bars mean citation burstness.

Discussion

General Information

From 2005 to 2024, a total of 954 papers on the mechanism of chronic atrophic gastritis (CAG) were published across 430 academic journals, involving 5686 authors from 3259 institutions in 177 countries/regions. Publication output demonstrated sustained growth over this period, reflecting consistent research engagement and advancing knowledge in CAG pathogenesis.

China led in productivity (41.51% of publications), followed by the USA (15.20%), Japan (9.01%), Italy (6.71%), and South Korea (6.50%). The USA exhibited high centrality (0.43), indicating its pivotal role in international collaborations. Institutional analysis revealed dominance by Chinese and American entities, such as Chengdu University of Traditional Chinese Medicine and Vanderbilt University, with intensified inter-institutional cooperation observed post-2018.

Journal analysis highlighted World Journal of Gastroenterology as the most productive journal, while Gastroenterology had the highest impact factor (IF = 25.7) and co-citation frequency. Author contributions were led by Liu Yuetao (16 publications), with CORREA P being the most co-cited author (n = 259), emphasizing foundational work on Helicobacter pylori and CAG pathogenesis.

Knowledge Base

Co-cited references, cited together by other publications, can measure the degree of relevance between papers. The knowledge base, characterized by the corresponding research community, is a collection of co-cited references. Furthermore, research papers with the highest co-citation frequency are an important research foundation in a certain field. In this bibliometric analysis, Table 5 further unraveled the multidisciplinary and evolving research framework underlying the mechanism of CAG, as evidenced by co-citation clustering of pivotal references. The five identified clusters (A-E) reflected both established and emerging paradigms in CAG research, bridging traditional therapeutic approaches, molecular pathology, and clinical translation.

Cluster A (Traditional Chinese Medicine) highlighted the growing scientific interest in ethnopharmacology and holistic interventions for CAG. The focus on Chinese medicinal compounds suggested a shift toward integrating traditional knowledge with modern mechanistic studies, particularly in modulating inflammation, epithelial repair, and Hp-induced damage. This cluster underscored the need for rigorous validation of herbal therapies through molecular and clinical studies to reconcile traditional practices with evidence-based medicine.^15–18 For example, traditional drugs-particularly compounds derived from TCM (eg, Sijunzi Decoction, Xiangsha Liujunzi decoction)-highlighted their emerging role in modulating inflammation, apoptosis, and signaling pathways (eg, TLR/TNF-α/NF-κB).^19,20

Cluster B (Macrophage Biology) emphasized the immunological dimension of CAG pathogenesis. By linking Hp infection to macrophage-driven mucosal remodeling, this cluster aligned with contemporary insights into host-microbe interactions, chronic inflammation, and immune-mediated atrophy. The prominence of macrophage biology reflected a broader trend in decoding the immune microenvironment’s role in gastric carcinogenesis, offering potential targets for immunomodulatory therapies.^21–24

Cluster C (Gastric Intestinal Metaplasia) reiterated the clinical urgency of addressing pre-neoplastic transitions, particularly the molecular and histopathological drivers of intestinal metaplasia (IM). The inclusion of diagnostic and therapeutic strategies in this cluster signaled translational efforts to intercept CAG progression, such as biomarker discovery and endoscopic surveillance protocols. However, gaps remained in understanding the reversibility of IM and its microenvironmental regulators.^25–28

Cluster D (Changing Face) likely explored the evolving clinical and immunological understanding of autoimmune atrophic gastritis (AAG), a subtype of CAG. This cluster may address advancements in autoantibody detection, genetic predispositions, and the interplay between autoimmune responses and gastric microenvironmental changes. The “changing face” metaphor suggested a redefinition of diagnostic criteria or therapeutic paradigms for AAG over the past two decades.^2,29,30

Cluster E (Antioxidant Systems Vitamin C) underscored oxidative stress as a critical mechanistic node in CAG progression. The focus on antioxidant defenses, particularly vitamin C, aligned with evidence linking Hp-induced oxidative DNA damage to gastric carcinogenesis. This cluster may highlight therapeutic strategies to restore redox balance, potentially synergizing with eradication therapies to mitigate atrophy and metaplasia.^31–34

The Analysis of Hotspots Evolution, Knowledge Structure, and Emerging Topics

Keywords co-occurrence, within the field of bibliometrics, can reflect the hotspots and trends of an academic discipline.³⁵ Table 4 elucidated the evolving research landscape and mechanistic focus of CAG, revealing key trends, hotspots, and interdisciplinary connections. The keyword co-occurrence analysis highlighted Helicobacter pylori as the most prominent keyword (372 occurrences), underscoring its central role in CAG pathogenesis. This aligned with decades of evidence linking Helicobacter pylori infection to chronic gastric inflammation, mucosal atrophy, and subsequent progression to gastric cancer – a trajectory further emphasized by high-frequency terms such as “gastric cancer” (176), “chronic atrophic gastritis” (113), “intestinal metaplasia” (87), and “inflammation” (78). The strong association between Helicobacter pylori infection and CAG-related carcinogenesis reflected the field’s sustained focus on microbial-driven mechanisms and their clinical implications (Figure 6A). The network cluster analysis shown in Figure 6B identified seven distinct research directions, with Cluster 1 (red, 83 items) likely representing Hp-centric studies, including its virulence factors, host-pathogen interactions, and carcinogenic pathways. Clusters 2–7 may encompass diverse themes such as molecular mechanisms (eg, “expression”, “apoptosis”, “oxidative stress”), histopathological transitions (eg, “intestinal metaplasia”, “dysplasia”), and clinical management (eg, “diagnosis”, “biomarkers”). The smaller clusters, particularly Cluster 7 (2 items), suggested niche or emerging topics warranting further exploration. The temporal evolution mapped by CiteSpace (Figure 7) revealed shifting priorities over two decades. Early research likely focused on Hp eradication and histopathological staging (eg, “atrophic gastritis”, “intestinal metaplasia”), while recent trends may emphasize molecular pathways (eg, “NF-κB”, “microRNA”), immune regulation, and early cancer detection. This progression mirrored advancements in omics technologies and a growing emphasis on precision medicine in CAG management.

Emerging and research topics of a certain field could be also characterized by references with intense citation bursts.³⁶ The citation burst analysis derived from Figure 8 provided critical insights into the intellectual dynamics and evolving research priorities in the field of CAG over the past two decades. The pronounced citation bursts observed in 2005 (28% of top 50 references) likely reflected pivotal advancements during this period, potentially linked to emerging consensus on CAG pathogenesis, diagnostic criteria, or therapeutic strategies. Subsequent bursts in 2007 and 2017 (10% each) may correspond to milestone studies or updated guidelines that reinvigorated scholarly interest in molecular mechanisms, such as Hp-induced mucosal injury, autoimmune pathways, or the role of epigenetic modifications in gastric atrophy progression. Notably, the strongest citation burst (strength: 11.79) was attributed to the Maastricht IV/Florence Consensus Report,¹⁴ published in GUT in 2012, which sustained its influence until 2022. This enduring impact underscored its foundational role in shaping clinical and research paradigms for Hp management – a key driver of CAG. Its prolonged burst duration aligned with ongoing debates about eradication protocols, virulence factors, and their interplay with host immune responses in CAG development. The finding that 94% of references exhibited citation bursts persisting until 2022 highlighted the sustained relevance of CAG-related research, particularly in elucidating mechanisms bridging chronic inflammation, metaplastic transformation, and carcinogenesis. However, the declining number of post-2017 bursts may signal a shift toward emerging themes (eg, microbiome dysbiosis, precision medicine) or methodological innovations (eg, single-cell sequencing, multi-omics integration) that warranted deeper exploration. Future studies should prioritize mechanistic investigations into the molecular cascades driving glandular atrophy and metaplasia, leveraging longitudinal bibliometric trends to identify underexplored pathways or therapeutic targets.

Limitations

There are some certain limitations inherent in our bibliometrics. First, data were sourced solely from the WoSCC, which may not uniformly cover all fields or journals, potentially leading to over- or underrepresentation of certain research areas. Second, the use of specific search terms and Boolean operators might have omitted relevant literature, introducing retrieval bias. Third, although CiteSpace and VOSviewer are robust tools, their outputs depend on data quality and completeness. Fourth, geographic inclusivity is limited, as Western and Chinese journals dominate the top rankings, potentially overlooking region-specific insights from high-prevalence areas like Latin America or Eastern Europe. Finally, bibliometric analysis prioritizes quantitative trends and may miss nuanced qualitative context. Additionally, while prolific authors were identified objectively, alternative metrics (eg, citation impact or clinical translation records) could complement productivity-based assessments. Meanwhile, though leading specialty journals are well-represented, the inclusion of guidelines among highly cited references highlights their consolidating role in evidence-based research trajectories. Future efforts should encourage equitable visibility for studies addressing regionally distinct risk factors, such as dietary habits or genetic predispositions, to enrich global mechanistic models.

Conclusion

This bibliometric analysis provides a comprehensive overview of the research landscape on the mechanism of CAG over the past two decades. A concise summary of the meaningful findings is as follows:

Leading Contributors: China and the USA were the leading contributors to CAG mechanism research over the past two decades, with China producing the highest volume of publications (41.51%) and the USA playing a central role in international collaboration.

Interdisciplinary Integration: The integration of TCM with modern molecular approaches has emerged as a promising interdisciplinary strategy, offering novel insights for CAG management.

Research Focus: Key research themes included Hp pathogenesis, macrophage biology, gastric intestinal metaplasia, and oxidative stress mechanisms.

Future Directions: The study emphasized the need for enhanced global collaboration, application of advanced technologies (eg, multi-omics), and translation of basic research into clinical practices for early diagnosis and personalized therapies.