The relationship between autoimmune atrophic gastritis (AIG) and dyspepsia is known, but the evidence is scarce. The aim of this 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.

All consecutive patients with histologically confirmed AIG referring to our Center from May 2022 to November 2025 were included and retrospectively analyzed. Clinical, biochemical, and histological variables were extracted from a dedicated database. Associations between dyspepsia subclasses and risk factors (i.e., smoking, Body Mass Index (BMI), gastrin, chromogranin levels) were tested using chi-square, Spearman and Mann-Whitney tests, with bootstrap-derived confidence intervals for effect sizes.

A total of 160 patients were included, 115 females (71,8%) and 45 males (29,2%) with a median age at the diagnosis of 56 years old (range 17-88 years old). Dyspeptic symptoms were reported by 55 patients (34,4%) at diagnosis, 45 females (81,8%) and 10 males (10,2%) with a median age at the diagnosis of 58,4 years old (range 27-88 years old). Postprandial Distress Syndrome (PDS) 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 levels (p=0.007, Cramér’s V=0.435), whereas PDS was inversely correlated with BMI (ρ=–0.195, p=0.036). No significant correlations were found between dyspeptic symptoms and gastrin, smoking or alcohol consumption. Of note, smoking emerged as a significant risk factor for body-fundus atrophy (p=0.023). 14 patients (25,45%) were prescribed proton pump inhibitors (PPI) by their general practitioner with total benefit in 3 cases (21,4%), partial in 2 (14,3%) and no benefit in the remaining 9 patients (64,3%). 20 patients (36,4%) were given mucosal protective agents with full benefit in 15 patients (75%), partial benefit in 4 (20%) and no benefit in 1 patient only (5%). 18 patients (32,7%) were prescribed prokinetics agents with full benefit in 9 patients (50%), partial benefit in 5 patients (27,8%)and no benefit in 4 patients (22%). Helicobacter Pylori was found in 12 patients (7.5%); once eradicated, 6 patients and 5 patients reported full/partial symptom improvement respectively, one patient only experienced no improvement.

Dyspepsia—mainly PDS and EPS—is a frequent manifestation of AIG, our data being in line with available literature. Elevated chromogranin 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. In current cohort, only few patients were prescribed PPIs with poor outcomes, and, in fact, PPI are generally discouraged in this subset of patients who are hypochlorhydric. The use of prokinetic and mucosal protective agents appear promising, but further data are warranted to better standardize their use.