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Aliment Pharmacol Ther. 2017 May;45(10):1358-1364. doi: 10.1111/apt.14045. Epub 2017 Mar 21.

Functional dyspepsia is associated with duodenal eosinophilia in an Australian paediatric cohort.

Author information

1
Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.
2
Department of Gastroenterology, John Hunter Children's Hospital, Newcastle, NSW, Australia.
3
Priority Research Centre GrowUpWell, University of Newcastle, Newcastle, NSW, Australia.
4
Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia.
5
Anatomical Pathology, John Hunter Hospital, Newcastle, NSW, Australia.
6
Anatomical Pathology, University of Newcastle, Newcastle, NSW, Australia.

Abstract

BACKGROUND:

The pathophysiology of functional dyspepsia (FD) remains unknown. Duodenal eosinophil infiltration has been reported.

AIM:

To assess the association between dyspeptic symptoms and duodenal eosinophilia in children undergoing upper gastrointestinal endoscopy.

METHODS:

In this retrospective cohort study, children with normal upper endoscopy and routine histology at a single tertiary paediatric centre between 2010 and 2014 were included. FD was defined as epigastric pain or discomfort >2 months without response to acid suppression. Controls presented with nonerosive reflux disease, dysphagia or rumination syndrome. Intramucosal eosinophil counts were compared between the groups using uni- and multivariate regression analyses.

RESULTS:

Thirty-six cases and 36 nonmatched controls were identified. Atopic history (39% vs. 25%) and psychological comorbidity (53% vs. 39%; both P = 0.2) were frequent in cases and controls. Self-reported nausea (64% vs. 17%; P < 0.0001), lethargy (19% vs. 0%; P = 0.005) and family functional gastrointestinal disorder(FGID) (28% vs. 3%; P = 0.003) were more common in cases than controls. Duodenal eosinophil counts [median (IQR): 151 (118-207) vs. 76 (60-106) per mm2 ; P < 0.001] were significantly higher in cases than controls with >112 eosinophils per mm2 predictive for FD (OR: 33.6, 95% CI: 7.1-159.0; P < 0.001). Duodenal eosinophilia was associated with weight loss (OR: 7.1, 95% CI: 1.1-45.5; P = 0.04).

CONCLUSIONS:

Functional dyspepsia in children is strongly associated with duodenal eosinophilia, in the absence of endoscopic or routine histological findings. Frequent atopic and psychological comorbidity illustrate likely multifactorial mechanisms.

PMID:
28326599
DOI:
10.1111/apt.14045
[Indexed for MEDLINE]
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