Original article—alimentary tract
Non-ulcer Dyspepsia and Duodenal Eosinophilia: An Adult Endoscopic Population-Based Case-Control Study

https://doi.org/10.1016/j.cgh.2007.05.015Get rights and content

Background & Aims: Functional abnormalities of the duodenum have been observed in non-ulcer dyspepsia. We aimed to identify whether eosinophils in the upper gastrointestinal tract are a biomarker for non-ulcer dyspepsia. Methods: A random sample of an adult Swedish population (n = 1001; mean age, 54 y; 51% female) underwent upper endoscopy. Non-ulcer dyspepsia cases (n = 51, Rome II) and randomly selected controls (n = 48) were identified. Two blinded independent observers assessed the gastroduodenal eosinophil counts. Eosinophils were quantified by counting the number per 5 high-power fields at each of 5 sites (cardia, body, antrum, D1 duodenal bulb, and D2 second portion of duodenum), and total counts were summed over the 5 fields at each site. Results: The odds ratio for non-ulcer dyspepsia (vs asymptomatic controls) in subjects with high duodenal bulb eosinophil counts (median, ≥22, relative to <22) was 11.7 (95% confidence interval, 3.9–34.9), adjusting for age, sex, and H pylori; similar results were observed in D2 (odds ratio = 7.3; 95% confidence interval, 2.9–18.1). A significant association with the number of eosinophil clusters was detected in the duodenum, with higher values in non-ulcer dyspepsia (P < .01). By immunostaining with major basic protein antibody in a subset of duodenal biopsy specimens, eosinophil degranulation was observed in non-ulcer dyspepsia (7 of 15 vs 0 of 5 controls; P = .11). Gastric eosinophil counts were overall not significantly increased in non-ulcer dyspepsia vs controls. Early satiety was associated with eosinophilia in D1 (P = .01) and D2 (P = .02), adjusting for age, sex, and H pylori. Conclusions: Duodenal eosinophilia may characterize a subset of adults with non-ulcer dyspepsia.

Section snippets

Setting

The study population was obtained from 2 neighboring communities in Northern Sweden, Kalix and Haparanda,19, 20, 21, 22, 23 with 18,408 and 10,580 inhabitants, respectively (as of December 1998). The distribution of age and sex was similar to the national average in Sweden in both communities.19 The Kalixanda study was approved by the Umeå University ethics committee and conducted in accordance with the revised Declaration of Helsinki.

Sampling

By using the computerized national population register,

Cases and Controls

No association of case/control status and demographic variables was observed, and in particular the prevalence of H pylori was similar (Table 1).

Upper Gastrointestinal Pathology

The mean intraepithelial lymphocyte count in the duodenum in non-ulcer dyspepsia cases was 13 (SD, ±6) compared with 13 (SD, ±6) in controls (P = .94, adjusting for age, sex, and H pylori status). Only 1 case of active duodenitis was seen and this was in a control H pylori–positive subject. No subject had visible intestinal parasites or cancer. None of

Discussion

We found a significant positive association for an eosinophil infiltrate in the duodenum with non-ulcer (functional) dyspepsia. There were greater odds for non-ulcer dyspepsia in adult subjects with increased duodenal eosinophil counts, adjusting for age, sex, and H pylori status. Duodenal eosinophilia was linked to specific dyspepsia symptoms. Furthermore, in those with increased gastric eosinophils, a greater odds for H pylori was observed, suggesting that infection may up-regulate eosinophil

References (51)

  • S. Khan

    Eosinophilic gastroenteritis

    Best Pract Res Clin Gastroenterol

    (2005)
  • J.K. Garrett et al.

    Anti-interleukin-5 (mepolizumab) therapy for hypereosinophilic syndromes

    J Allergy Clin Immunol

    (2004)
  • L. Agreus et al.

    The cost of gastro-oesophageal reflux disease, dyspepsia and peptic ulcer disease in Sweden

    Pharmacoeconomics

    (2002)
  • K.J. Lee et al.

    A pilot study on duodenal acid exposure and its relationship to symptoms in functional dyspepsia with prominent nausea

    Am J Gastroenterol

    (2004)
  • M.P. Schwartz et al.

    Effect of inhibition of gastric acid secretion on antropyloroduodenal motor activity and duodenal acid hypersensitivity in functional dyspepsia

    Aliment Pharmacol Ther

    (2001)
  • G. Holtmann et al.

    Impaired small intestinal peristaltic reflexes and sensory thresholds are independent functional disturbances in patients with chronic unexplained dyspepsia

    Am J Gastroenterol

    (1996)
  • K.J. Lee et al.

    Influence of duodenal acidification on the sensorimotor function of the proximal stomach in humans

    Am J Physiol

    (2004)
  • G.R. Locke et al.

    Overlap of gastrointestinal symptom complexes in a US community

    Neurogastroenterol Motil

    (2005)
  • N.J. Talley et al.

    Identification of distinct upper and lower gastrointestinal symptom groupings in an urban population

    Gut

    (1998)
  • H. Tornblom et al.

    Inflammation as a cause of functional bowel disorders

    Scand J Gastroenterol

    (2005)
  • C.A. Friesen et al.

    Mucosal eosinophilia and response to H1/H2 antagonist and cromolyn therapy in pediatric dyspepsia

    Clin Pediatr

    (2006)
  • S.J. Kalantar et al.

    Dyspepsia due to eosinophilic gastroenteritis

    Dig Dis Sci

    (1997)
  • P. Aro et al.

    Valid symptom reporting at upper endoscopy in a random sample of the Swedish adult general populationThe Kalixanda study

    Scand J Gastroenterol

    (2004)
  • J. Ronkainen et al.

    High prevalence of gastroesophageal reflux symptoms and esophagitis with or without symptoms in the general adult Swedish population: a Kalixanda study report

    Scand J Gastroenterol

    (2005)
  • P. Aro et al.

    Body mass index and chronic unexplained gastrointestinal symptoms: an adult endoscopic population-based study

    Gut

    (2005)
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    Supported in part by the Swedish Research Council; the Swedish Society of Medicine; Mag-tarm sjukas förbund, Norrbotten County Council, Sweden; AstraZeneca R&D, Sweden; and the University of Sydney.

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