Objective: To identify risk factors associated with endoscopic atrophic progression of gastric mucosa after Helicobacter pylori (H.pylori) eradication and to develop a risk scoring system, aiming to establish an individualized endoscopic follow-up strategy for patients with chronic gastritis. Methods: This retrospective cohort study included patients with chronic gastritis who visited the Department of Gastroenterology at Beijing Friendship Hospital and successfully eradicated H.pylori between January 2018 and October 2021. General patient information, endoscopic findings, and other clinical data were collected. Endoscopic outcomes before and after follow-up were compared to classify patients into progression and non-progression groups. Univariate and multivariate analyses were performed to identify independent risk factors for endoscopic atrophic progression. A risk scoring system was then constructed based on these factors. Results: Gastric ulcer (OR = 4.24, P = 0.008, 95% CI: 1.468–12.258), history of proton pump inhibitor (PPI) use (OR = 4.06, P = 0.007, 95% CI: 1.460–11.274), alcohol consumption (OR = 3.77, P = 0.002, 95% CI: 1.644–8.678), high-salt diet (OR = 2.90, P = 0.008, 95% CI: 1.321–6.412), and high red meat intake (OR = 2.33, P = 0.025, 95% CI: 1.115–6.318) were identified as independent risk factors for endoscopic atrophic progression after H.pylori eradication. The predictive model based on these five factors showed good performance, with an area under the receiver operating characteristic curve (AUC) of 0.813 (95% CI: 0.755–0.876, P < 0.001). Conclusion: Patients with chronic gastritis remain at risk of disease progression even after successful H.pylori eradication. Individualized endoscopic follow-up strategies should be considered based on patients’ medical history, medication use, lifestyle, and dietary habits.