Duodenal Eosinophilia Associated With Functional Dyspepsia

Increased duodenal eosinophil densities may be a marker of proton pump inhibitor therapy-mediated alleviation of dyspeptic symptoms in postprandial distress syndrome.

Low-grade duodenal eosinophilia is associated with functional dyspepsia (FD) in the Helicobacter pylori (H pylori)-negative postprandial distress syndrome (PDS) subtype, according to study results published in the Journal of Clinical Gastroenterology.

Researchers conducted a prospective, observational study that comprised newly diagnosed patients aged 18 to 70 years with FD symptoms based on Rome-III criteria who underwent upper gastrointestinal endoscopy in Argentina from January 2014 to November 2020.

The presence of H pylori was assessed on gastric biopsies with use of Giemsa staining. Duodenal inflammation was assessed semiquantitatively on hematoxylin and eosin slides for the presence and severity of microscopic duodenitis.

A total of 516 patients (60% women; median age, 51 [IQR, 20.5] years) were included in the study. Among the FD subtypes, 231 (45%) patients had epigastric pain syndrome (EPS), 168 (33%) had PDS, and 117 (22%) had EPS/PDS overlap. In addition, 259 participants (50.3%) were positive for H pylori infection.

Histologic duodenal grading of chronic inflammation showed no differences among the FD subtypes. The PDS group had significantly increased duodenal eosinophil (D-EO) densities compared with the EPS and EPS/PDS overlap groups. Of the PDS group, 57% had D-EO of  more than 10 per high power field (HPF) vs 33% in the EPS and 16% in EPS/PDS overlap subtypes (P <.05).

The odds ratio (OR) for PDS vs non-PDS FD subtypes with D-EO was 2.28 (95% CI, 1.66-3.14; P <.0001). The OR was 3.6 (95% CI, 2.45-5.28; P <.0001) after adjusting for age, sex, H pylori, and nonsteroidal anti-inflammatory drug use, which indicated that D-EO of more than 10 per HPF is associated with the PDS subtype.

[D]uodenal eosinophilia is associated with FD in the PDS subtype and revealed that duodenal eosinophilia is a useful histologic marker of proton pump inhibitor therapy response in PDS non–H pylori FD patients.

An increase in D-EO densities was found in 189 patients with FD (36.6%) with a cutoff D-EO of more than 10 per HPF. Duodenal eosinophilia in H pylori-negative participants was most accurate for PDS with area under the curve (AUC) of 0.731 (±0.032, SE) vs H pylori-positive patients with PDS with AUC of 0.598 (±0.045, SE) (P =.016).

The researchers also assessed whether an increase in D-EO densities affects the efficacy of the standard of care of FD (pantoprazole 40 mg or esomeprazole 40 mg once daily 30 minutes before the first meal and nutritional counseling for 4 to 6 weeks). Among 96 H pylori-negative patients with PDS, a significantly greater proportion of those who had resolved PDS symptoms of early satiety and postprandial fullness occurred in the group with high D-EO density (early satiety score, 0 to 1; 69.8%; P =.0028; postprandial fullness score, 0 to 1; 73%; P =.0003) vs low D-EO density (early satiety score, 0 to 1; 37.2 %; postprandial fullness score, 0 to 1; 34%).

Study limitations include the absence of healthy volunteers, and only samples from the second portion of the duodenum were included. The cohort also comprised the northeastern Argentinean population in which a high prevalence of H pylori was expected.

“The results of this prospective observational real-life setting study suggest that duodenal eosinophilia is associated with FD in the PDS subtype and revealed that duodenal eosinophilia is a useful histologic marker of proton pump inhibitor therapy response in PDS non–H pylori FD patients,” the study authors conclude.

References:

Barreyro FJ, Caronia MV, Elizondo K, et al. Clinical implications of low-grade duodenal eosinophilia in functional dyspepsia: a prospective real-life study. J Clin Gastroenterol. Published online November 25, 2022. doi: 10.1097/MCG.0000000000001812