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Helicobacter pyloriis a major risk factor for chronic atrophic gastritis (CAG). A large variety of definitions of CAG have been used in epidemiologic studies in the past. The aim of this work was to systematically review and summarize estimates of the association betweenH. pyloriinfection and CAG according to the various definitions of CAG. Articles on the association betweenH. pyloriinfection and CAG published until July 2007 were identified. Separate meta-analyses were carried out for studies defining CAG based on gastroscopy with biopsy, serum pepsinogen I (PG I) only, the pepsinogen I/pepsinogen II ratio (PG I/PG II ratio) only, or a combination of PG I and the PG I/PG II ratio. Numbers of identified studies and summary odds ratios (OR) (95% confidence intervals) were as follows: gastroscopy with biopsy:n= 34, OR = 6.4 (4.0–10.1); PG I only:n= 13, OR = 0.9 (0.7–1.2); PG I/PG II ratio:n= 8, OR = 7.2 (3.1–16.8); combination of PG I and the PG I/PG II ratio:n= 20, OR = 5.7 (4.4–7.5). Studies with CAG definitions based on gastroscopy with biopsy or the PG I/PG II ratio (alone or in combination with PG I) yield similarly strong associations ofH. pyloriwith CAG. The association is missed entirely in studies where CAG is defined by PG I only. © 2008 Wiley-Liss, Inc.