Functional dyspepsia and duodenal eosinophilia: A new model

Area of Science:

• Gastroenterology
• Immunology
• Microbiome research

Background:

• Functional dyspepsia (FD) affects over 10% of the population, with evolving understanding of its pathophysiology.
• The Rome IV criteria suggest overlap between FD, GERD, and IBS, indicating a potential shared disease spectrum.
• Helicobacter pylori infection is a cause in a minority of cases, with H. pylori-associated dyspepsia now a separate entity.

Purpose of the Study:

• To review current understanding of functional dyspepsia pathophysiology.
• To highlight emerging risk factors and mechanisms, including duodenal inflammation and microbiome alterations.
• To discuss the implications for future therapeutic strategies.

Main Methods:

• Review of recent research on FD pathophysiology.
• Analysis of Rome IV criteria and associated conditions.
• Examination of risk factors including infection, atopy, and antibiotic exposure.
• Investigation of immune system activation and gut-brain axis involvement.

Main Results:

• Duodenal inflammation (eosinophils, mast cells) may compromise the intestinal barrier.
• Post-infectious gastroenteritis, atopy, pets, antibiotics, and microbiome disturbances are identified risk factors.
• FD is associated with immune activation, altered T cells, increased cytokines, and potential autoimmune links.
• Psychological factors may be influenced by gut mechanisms, not solely driving FD.

Conclusions:

• Current FD treatments offer limited relief, necessitating new approaches.
• Targeting duodenal inflammation and microbiome alterations holds promise for future FD cures.
• Advances in understanding FD pathophysiology are expected to transform clinical practice.