Background: Atrophic gastritis and intestinal metaplasia are precancerous conditions associated with Helicobacter pylori infection. The prevalence of these conditions varies among countries and even among different regions in same country. There is limited data from central Nepal regarding these entities. The primary aim of this study was to assess the prevalence of atrophic gastritis in gastric biopsy of symptomatic patients. Methods: A prospective study which included all consecutive patients undergoing endoscopic gastric biopsy. Biopsies from body and antrum obtained as per Sydney protocol. Histopathological examination was done by a team of histopathologists and reported according to updated Sydney classification. Statistical software SPSS (version 26, SPSS Inc. Chicago, IL) and STATA 14 were used for statistical analysis. Results: Of 113 consecutive patients, 103 were included for final analysis (female: 59.2% and mean age: 46.29 ± 16.54 years). Dyspepsia [EPS: 69 (66.9%) and PDS:19 (18.4%)] followed by GERD in 21 (20.3%) were the commonest presentations. On histology, atrophic gastritis was present in 101 (98.05%) patients with mild-, moderate-, and severe AG seen in 12 (11.8%), 87 (86.1%), and 2 (1.9%) respectively. Prevalence of AG was not different in patients with or without H. pylori infection (p=0.10). Intestinal metaplasia was present in 13 (12.62%). Helicobacter pylori were present in 58 (56.3%) with prevalence in antrum and body being 57 (55.3%) vs. 41 (39.8%), p=0.02. Conclusions: Atrophic gastritis, IM, and H. pylori infection is highly prevalent in symptomatic patients and the prevalence in younger population is equally high compared to older population.