Chronic atrophic gastritis and dyspepsia: a forgotten link?

Introduction: The relationship between chronic atrophic gastritis and dyspeptic symptoms has been suggested since the early 20th century, however, current evidence is scarce and no study has sistematically assessed this link. Areas covered: We conducted a narrative review to assess the association between chronic atrophic gastritis (either corpus-restricted or multifocal) and dyspeptic symptoms based on the available evidence. A literature search was conducted on PubMed up to February 2025, using the SANRA scale. About 30% of patients with corpus atrophic gastritis report dyspeptic symptoms, while the prevalence of dyspepsia in patients with corpus atrophic gastritis was about 8%. Other issues addressed were: the pathogenetic mechanisms involved in dyspeptic symptoms generation, the topographic assessment of gastric atrophy, the characterization of dyspeptic symptoms and the paucity of available medical treatment. Expert opinion: In the coming years, more rigorous studies should be conducted to achieve a deeper understanding of the association between corpus atrophic gastritis and dyspeptic symptoms, to better elucidate the pathogenetic mechanisms underlying this link, and to evaluate possible treatment options.