What are the symptoms of atrophic gastritis?

Symptoms of Atrophic Gastritis

Atrophic gastritis is typically asymptomatic and may go undiagnosed, or present with nonspecific symptoms that occur later in the disease course. 1

Gastric Symptoms

The most common gastric manifestations when symptoms do occur include:

• Epigastric pain or discomfort that may worsen after eating 2
• Nausea and vomiting, which can be persistent or cyclical 2
• Early satiety (feeling full after eating small amounts of food) 2
• Bloating and abdominal distension 2
• Heartburn or acid reflux symptoms 2
• Dyspepsia that doesn't respond to standard treatments 2

These symptoms are nonspecific and often mild, contributing to the underdiagnosis of this condition. 1

Extragastric Manifestations

The extragastric symptoms are often more clinically significant and may be the presenting features:

Anemia-Related Symptoms

• Iron deficiency anemia presenting as fatigue, weakness, and pale skin—occurs in up to 50% of patients with corpus-predominant atrophic gastritis and often presents earlier than B12 deficiency 1
• Vitamin B12 deficiency causing severe weakness, fatigue, and neurological symptoms (particularly in autoimmune gastritis) 1, 2
• Pernicious anemia as a late-stage manifestation of autoimmune gastritis, characterized by megaloblastic anemia 1

Autoimmune-Associated Symptoms

• Symptoms of autoimmune thyroid disease (present in up to one-third of patients with autoimmune gastritis) 1, 3
• Manifestations of other autoimmune conditions including type 1 diabetes mellitus and Addison's disease 1

Symptoms by Etiology

H. pylori-Associated Atrophic Gastritis

• May be completely asymptomatic or present with mild dyspeptic symptoms 2, 3
• Increases risk of peptic ulcer disease symptoms 2

Autoimmune Gastritis

• Often asymptomatic until advanced stages 2, 3
• May present initially with symptoms of pernicious anemia (fatigue, neurological symptoms) rather than gastric symptoms 2
• Gradual development of micronutrient deficiencies over time 2

Atypical Presentations

Clinicians should be aware of less common presentations:

• Atypical chest pain that can be confused with cardiac symptoms 2
• Nonspecific symptoms like postprandial fullness 2
• Incidentally discovered gastric neuroendocrine tumors (typically asymptomatic small nodules <10 mm in the corpus or fundus) 1

Clinical Pitfall

The key clinical challenge is that atrophic gastritis is frequently asymptomatic in early stages, making it an underdiagnosed condition despite affecting up to 15% of the US population. 1 This underscores the importance of maintaining a high index of suspicion in patients with unexplained iron or vitamin B12 deficiency, autoimmune thyroid disease, or persistent dyspepsia, as these may be the only clues to the diagnosis. 1