Introduction
Autoimmune atrophic gastritis (AIG) is a progressive, chronic, immune-mediated inflammatory disease characterized by the destruction of gastric parietal cells leading to hypo/anacidity. Clinical manifestations of AIG are often subtle, but the relationship between AIG and dyspeptic symptoms has already been reported, even though current evidence is scarce as well as the underlying pathophysiology is still unclear.
Aims & Methods
The aim of our study was to evaluate the prevalence of dyspepsia and its subclasses and to evaluate correlations between clinical and biochemical parameters in a cohort of patients with AIG at a tertiary referral center. We conducted a single-center, retrospective observational study. Patients with histologically confirmed AIG referring to our Center at IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy from May 2022 to November 2025 were included. Associations between dyspepsia subclasses and risk factors (i.e., smoking, Body Mass Index-BMI, gastrin, Chromogranin A-CgA) were tested using chi-square, Spearman and Mann-Whitney tests.
Results
160 patients (114 females/46 males), with a median age at diagnosis of 56 years old (range 20-88 years) were included. Dyspeptic symptoms at diagnosis were reported by 55 patients (34.4%). Postprandial Distress Syndrome (PSD) was the most frequent subtype (20%), followed by Epigastric Pain Syndrome (EPS) (9.4%), reflux-like symptoms (8.8%), and nausea/vomiting (6.2%). EPS showed a significant association with elevated chromogranin A levels (p = 0.007, Cramér’s V = 0.435), whereas PDS was inversely correlated with BMI (ρ = −0.195, p = 0.036). Smoking emerged as a significant risk factor for body–fundus atrophy (p = 0.023). An inverse correlation was observed regarding the presence of dyspepsia and the development of type 1 gastric Neuroendocrine Tumors (p=0.018, Fisher’s exact p=0.010). Regarding empirical treatments, , proton pump inhibitors were largely ineffective (no benefit in 46.1% of cases). Conversely, mucosal protective agents and prokinetic drugs provided complete or partial symptom relief in the vast majority of treated patients (94.1% and 66.7%, respectively).
Conclusion
Dyspepsia—mainly PDS and EPS—is a frequent manifestation of AIG. Elevated CgA levels correlate with EPS, suggesting a potential link with neuroendocrine hyperplasia, while lower BMI is associated with PDS, indicating possible nutritional impairment in symptomatic patients. The management of dyspepsia in the setting of AIG is challenging. The use of prokinetic and mucosal protective agents appear promising, but further data are warranted to better standardize their use.
References
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