Objective: To investigate chronic atrophic gastritis (CAG) endoscopy and clinical pathological diagnosis correlation. Methods: Selected 220 cases patients from January 2014 to April 2015 due to gastrointestinal symptoms underwent endoscopy and pathological examination in our hospital, compared endoscopy and histological findings. Results: In the 220 patients, 65 patients with CAG were diagnosed by gastroscopy, and 155 patients with NAG; the pathological diagnosis was CAG in 63 patients and 157 patients with NAG. The coincidence rate of gastroscopy and pathological diagnosis was 88.18%, and gastroscopy and pathology diagnosis consistency check K=0.714, P<0.05; endoscopic were mainly red and white or white and mucosal rough and granular hyperplasia performance pathologic diagnosis confirmed CAG coincidence rate were 85.71% and 96.30%, the difference was not statistically significant (P>0.05); endoscopic antral mucosa was decreased, vascular permeability type presentation pathologic diagnosis as CAG comply with 41.18%, significantly lower than other endoscopic features, the difference was statistically significant (P<0.05); endoscopic mucosa rough and granular hyperplasia type HP positive rate was 88.89%, significantly higher than other endoscopic features, the difference was statistically significant (P<0.05). Conclusion: Endoscopic diagnosis of chronic atrophic gastritis and histological results are in good agreement, but there are still differences, the clinical diagnosis must be combined with pathological examination.