Paradoxical association between dyspepsia and autoimmune chronic atrophic gastritis: Insights into mechanisms, pathophysiology, and treatment options

Table 1 Reported upper gastrointestinal symptoms and the underlying pathophysiological mechanisms in patients with autoimmune atrophic gastritis

Clinical manifestation	Pathophysiological mechanisms
Dyspeptic symptoms
Postprandial fullness; Early satiety; Epigastric pain	Hypochlorhydria. Delayed gastric emptying due to: Hormonal effects (ghrelin, motilin); Reduced acid secretion. Visceral hypersensitivity. Low-grade chronic inflammation. Changes in the gut microbiota
Typical GER like symptoms
Heartburn; Regurgitation	Non-acid reflux; Delayed gastric emptying; Visceral hypersensitivity; Changes in the gut microbiota
Atypical GERD-like symptoms
Cough; Non-cardiac chest pain; Dysphagia	Delayed gastric emptying; Visceral hypersensitivity
Overlap dyspepsia-GER like symptoms	As above
Vomiting	Delayed gastric emptying; Visceral hypersensitivity
Nausea	Delayed gastric emptying
Fatigue	Impaired absorption of iron and vitamin B12

GER: Gastro-esophageal reflux; GERD: Gastroesophageal reflux disease.