Objective To investigate the correlation between intestinal metaplasia (IM) characteristics with Helicobacter pylori (Hp) infection and gastrointestinal hormones in the elderly with chronic atrophic gastritis (CAG). Methods From January 2019 to June 2023,130 elderly patients with CAG and IM in Dangtu People′s Hospital of Anhui Province were selected as the IM group, and 130 CAG elderly patients without IM as the non-IM group during the same period. The correlation between IM characteristics, Hp infection and gastrointestinal hormones [pepsinogenⅠ (PGⅠ), pepsinogen Ⅱ(PGⅡ), and gastrin-17 (G-17)] was analyzed. SPSS 22.0 was used for data analysis. According to the data type, comparison between groups was performed using t test, analysis of variance or Chi-square test respectively. Pearson correlation analysis was used to evaluate the correlation between IM characteristics, Hp infection and gastrointestinal hormones. Results The proportions of Hp infection and serum G-17 level in the IM group were higher than those in the non-IM group (P<0.05), the PGⅡ was lower than that in non-IM group, and the difference was statistically significant (P<0.05). The proportion of incomplete IM morphology, severe inflammation and Sydney score of the patients with Hp infection (Hp group) in the IM group were higher than those in the non-Hp infection group (non-Hp group), and the difference was statistically significant (P<0.05). PGⅠ/PGⅡ in IM incomplete morphology in the IM group was lower than that of the complete morphology, and the PGⅠ/PGⅡ in patients with mild, moderate and severe inflammation decreased in order. The G-17 level in IM incomplete morphology was higher than that of complete morphology, and the G-17 level increased in order in patients with mild, moderate and severe inflammation, with statistically significant differences (P<0.05). Pearson correlation analysis showed that the Sydney score of the IM patients was negatively correlated with PGⅠ/PGⅡ (r=-0.592; P<0.001) and was positively correlated with G-17 (r=0.624; P<0.001). Conclusion Hp infection, PGⅠ/PGⅡ and G-17 have correlation with IM morphology, inflammation degree and Sydney score.