Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2023; 29(23): 3733-3747
Published online Jun 21, 2023. doi: 10.3748/wjg.v29.i23.3733
Paradoxical association between dyspepsia and autoimmune chronic atrophic gastritis: Insights into mechanisms, pathophysiology, and treatment options
Roberta Elisa Rossi, Alessandra Elvevi, Valentina Sciola, Francesco Vito Mandarino, Silvio Danese, Pietro Invernizzi, Sara Massironi
Roberta Elisa Rossi, Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano 20089, Milan, Italy
Alessandra Elvevi, Pietro Invernizzi, Sara Massironi, Gastroenterology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza 20900, Italy and Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
Valentina Sciola, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano 20100, Italy
Francesco Vito Mandarino, Silvio Danese, Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan 20132, Italy
Silvio Danese, School of Medicine, Vita-Salute San Raffaele University, Milan 20132, Italy
Author contributions: Massironi S conceived the idea for the review; Rossi RE, Elvevi A, Sciola V, and Mandarino FV conducted the literature search; Rossi RE, Elvevi A, and Sciola V screened the articles for inclusion and exclusion criteria; Rossi RE, Sciola V, and Elvevi A wrote the initial draft of the manuscript; Massironi S, Mandarino FV, Danese S, and Invernizzi P contributed to revising the manuscript critically for important intellectual content and finally all authors approved the final version for submission.
Conflict-of-interest statement: All the authors declare no conflict of interests for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Sara Massironi, MD, PhD, Chief Physician, Doctor, Medical Assistant, Research Scientist, Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, Monza 20900, Italy.
Received: March 21, 2023
Peer-review started: March 21, 2023
First decision: April 12, 2023
Revised: April 23, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: June 21, 2023
Processing time: 86 Days and 18.6 Hours
Research background

Gastrointestinal symptoms such as dyspepsia and early satiety are very common in autoimmune gastritis (AIG), being second in terms of frequency only to anemia, which is the most typical feature of AIG. Understanding the pathophysiology of each condition can also guide the choice of appropriate treatments, including lifestyle modifications, dietary changes, and medication management.

Research motivation

The management of dyspepsia in patients with AIG, a chronic, immune-mediated disease, remains a challenge, as it can overlap with functional dyspepsia and gastroesophageal reflux disease. Currently, there are no specific therapies. A tailored treatment approach based on a better understanding of putative pathogenic mechanisms underlying symptoms is needed.

Research objectives

In this review, we will discuss the putative pathogenic mechanisms underlying symptom generation in AIG, their clinical implications, and the current management strategies for this complex and multifaceted disease.

Research methods

An extensive bibliographical search was performed in PubMed to identify guidelines and primary literature (retrospective and prospective studies, systematic reviews, case series) published in the last 10 years, using both medical subject heading terms and free-language keywords: Dyspepsia; dyspeptic symptoms; gastro-intestinal symptoms; chronic autoimmune atrophic gastritis; diagnosis; treatment.

Research results

A total of 125 records were reviewed and 80 were defined as fulfilling the criteria.

Research conclusions

AIG can cause a range of clinical manifestations, including dyspepsia. The pathophysiology of dyspepsia in AIG is complex and involves changes in acid secretion, gastric motility, hormone signaling, and gut microbiota, among other factors. Managing dyspeptic symptoms of AIG is challenging and currently, there are no specific therapies. A tailored treatment approach based on a better understanding of putative pathogenic mechanisms underlying symptoms is needed. While proton pump inhibitors are commonly used to treat dyspepsia and GERD, they may not be appropriate for AIG. Prokinetic agents, antidepressant drugs, and non-pharmacological treatments may be of help, even if not adequately evidence-based supported. A multidisciplinary approach for the management of dyspepsia in AIG is recommended, and further research is needed to develop and validate more effective therapies for dyspepsia.

Research perspectives

As a future perspective, targeting dyspepsia in AIG based on changes in the microbiota and advanced endoscopic techniques to treat severe dyspeptic symptoms might be an area of ongoing research.