Factors associated with dyspepsia and therapeutic approaches in autoimmune atrophic gastritis: a real-world observational study

Factors associated with dyspeptic subtypes in autoimmune gastritis (AIG) and the efficacy of available empirical treatments remain largely unexplored, representing a significant unmet clinical need in daily gastroenterological practice. To assess the prevalence and factors associated with dyspepsia and its subtypes in a cohort of AIG patients, and to evaluate real-world symptom improvement following different therapeutic approaches. Retrospective analysis of consecutive patients with histologically confirmed AIG referred to our Center (May 2022-November 2025). Dyspepsia was classified according to Rome IV criteria. Clinical, biochemical, histological variables, along with therapeutic outcomes were systematically evaluated. Treatment response was retrospectively reconstructed from routine clinical documentation and was analyzed descriptively. Out of 160 AIG patients (71.2% females, mean age 56.2 ± 14.3 years), 55 (34.4%) reported dyspeptic symptoms at diagnosis. Postprandial Distress Syndrome (PDS) was the most frequent subtype (20.0%), followed by Epigastric Pain Syndrome (EPS, 9.4%). EPS was associated with higher laboratory-normalized CgA categories (Freeman–Halton exact p = 0.005), whereas BMI showed a weak inverse correlation with PDS (Spearman’s ρ = −0.195, p = 0.036). Regarding empirical treatments, proton pump inhibitors had no benefit in 46.1% of cases; mucosal protective agents and prokinetic drugs provided complete/partial symptom relief in the majority of treated patients (94.1% and 73.3%, respectively). Dyspepsia, primarily PDS and EPS, is a frequent and often mismanaged clinical manifestation of AIG. In this cohort, elevated laboratory-normalized CgA categories were associated with EPS, whereas lower BMI showed a weak exploratory association with PDS. Although treatment findings should be interpreted cautiously because of the retrospective, uncontrolled design, the favorable symptom improvement observed with mucosal protective agents and prokinetics supports further prospective evaluation of these therapeutic strategies in patients with AIG-related dyspepsia.