Association of duodenal eosinophilia with Helicobacter pylori-negative functional dyspepsia

The pathogenesis of functional dyspepsia (FD) is complex and still remains to be established. Recent studies support duodenal inflammation with increased infiltration of eosinophils and a higher level of systemic cytokines among patients with FD. These findings may help to understand the underlying pathophysiology of FD. The aim of this study was to evaluate the association between duodenal eosinophilia and FD.

A total of 84 patients (42 cases of FD and 42 subjects without dyspepsia as control, mean age 31 years, 56% female) were recruited for this prospective observational study. FD was diagnosed by validated Bangla version of the ROME III criteria. Patients with no symptoms of FD who were referred for upper gastrointestinal endoscopy for other reasons were included as control. Biopsy specimens were taken from the second part (D2) of the duodenum of all participants. The eosinophil count was quantitatively evaluated by hematoxylin and eosin staining and expressed in numbers per 5 HPF. The association between duodenal eosinophilia (defined as ≥22/5HPF a priori) and FD was assessed.

Significantly increased duodenal eosinophil count was found in patients with FD than patients without dyspepsia (p = 0.001). 57.1% of patients with FD had duodenal eosinophilia. A significant positive association was found between duodenal eosinophilia and FD (OR = 5.67, 95% CI 1.92-17.2, p = 0.001). A positive association was also observed between duodenal eosinophilia and postprandial distress syndrome (OR = 5.54, 95% CI 0.86-45.24, p = 0.036). A higher odds ratio was noticed among those who complain of early satiety.

A significant positive association was found between duodenal eosinophilia and FD especially among those with postprandial distress syndrome. It requires further large scale multicenter studies to establish duodenal eosinophilia as a biomarker of FD.