The Relationship Between Functional Dyspepsia And Duodenal Eosinophils

Functional dyspepsia(FD)is a common functional gastrointestinal disorder impacting 20%of people worldwide and up to 24%of Chinese population.FD is diagnosed by using symptom-based Rome ? criteria,and characterized by symptoms of postprandial fullness,early satiation,epigastric pain.Patients usually undergo repeated medical examinations leading to substantial use of healthcare resources.There has been a large focus on altered gastro-duodenal motility,gastro-duodenal hypersensitivity to gastric distention,Helicobacter pylori(H.pylori)infection,and psychological disturbance.Currently,there is increasing evidence for the presence of low-grade immune activation in the duodenal mucosa of patients with FD.In a population-based case-control study,a higher proportion of patients with FD had duodenal eosinophila was observed compared to asymptomatic controls.A study of pediatric patients who had dyspepsia found that in 71%had duodenal eosinophilia.Eosinophil is maily present in gastrointestinal mucosa,and exerts biological functions almost exclusively by release of mediators after activation.Eosinophils and mast cells interact highly with each other.Talley et al speculated that duodenal eosinophilia would be a positive pathologic marker for functional dyspepsia and functioned through eosinophil-mast cell-nerve gut axis.Aims1.To compare the total number of gastro-duodenal eosinophil between patients with FD and HCs in Chinese population.2.To evaluate the eosinophil degranulation positive rate,number of duodenal degranulated eosinophil and mast cell between patients with FD and HCs.3.To evaluate associations of specific FD subtypes or symptoms and H.pylori infection status with the number of gastro-duodenal eosinophils.MethodsThis was a case-control study.1.We consecutively recruited patients newly diagnosed FD,and asymptomatic controls who were scheduled to undergo upper gastrointestinal endoscopy as part of annual health examination or surveillance of gastrointestinal metaplasia at outpatient gastroenterology clinic of Sir Run Run Shaw hospital from March 2014 to May 2014.2.All participants completed a group of questionnaires contained basic characteristics,Hospital Anxiety and Depression Scale(HADS),and simplified abdominal symptom questionnaire,which contains the frequency and severity of abdominal symptoms.3.All recruited participants underwent upper gastrointestinal endoscopy,and routine examination of blood,stool ovum,serological total IgE,and anti-tissue transglutaminase antibody(tTG-IgA).H.pylori infection was determined by positivity of both C13 breath test and gastric histology.4.Immunohistochemistry(IHC)stains were used to evaluate the expression of major basic protein(MBP)and tryptase,which are markers of eosinophil and mast cell degranulation,respectively.Results1.Ninety-six patients with FD and 24 healthy controls were included in this pilot study.There were no significant differences in age,frequency of smoking,alcohol drinking,and education between two groups,as well as H.pylori positivity rate(22.9%vs 29.2%,P=0.522).The body mass index(BMI)score in patients with FD was significantly lower than asymptomatic controls(22.2±3.0 vs 24.4±3.3,P=0.002).While the anxiety(6.2±2.7 vs 1.9±1.2,P<0.001)and.depression scores(1(0?3)vs 0(0?0),P<0.001)in patients with FD were significantly higher than healthy controls(P<0.05).2.The eosinophil counts at D2 and D1 in two groups were quite similar.There was also no significant difference of eosinophil counts at stomach between patients and controls(P>0.05).3.Eosinophil degranulation was observed in 49(59%)of 83 patients with FD,while 6(25%)of 24 healthy controls(59%vs 25%,P=0.003).Eosinophil degranulation was observed in 53(64%)of 81 patients with FD,while 11(46%)of 24 healthy controls(64%vs 46%,P=0.084)in D1.Moreover,compared with healthy controls,the number of degranulated eosinophil in patients with FD showed an increased trend in D2(10.7±7.7 vs 5.3±0.9,P=0.077)and significant increase in D1(9.8±6.3 vs 2.9±2.1,P=0.002).4.There was a positive relationship between the frequency of fullness and eosinophil counts(?=0.11 se=0.05,P<0.05)and a negative relationship between the frequency of epigastric pain and eosinophil counts(?=-0.09,se=0.04,P<0.05)in gastric body.5.Eosinophil counts were significantly related to H.pylori infection in gastric antrum and body in comparison with those who were not infected in both patient and control groups.Conclusions1.Patients with FD were characterized by increased infiltration of degranulated eosinophils in duodenal mucosa compared to healthy controls with comparable total number of eosinophils(HE staining)in gastro-duodenal tract.The duodenal degranulated eosinophils may be a potential bio-marker for FD.2.There was a positive relationship between the frequency of fullness and eosinophil counts a negative relationship between the frequency of epigastric pain and eosinophil counts.3.Gastric eosinophil counts were significantly related to H.pylori infection.