Non-ulcer Dyspepsia and Duodenal Eosinophilia: An Adult Endoscopic Population-Based Case-Control Study

• Published in: Clinical gastroenterology and hepatology Vol. 5; no. 10; pp. 1175 - 1183
• Main Authors: Talley, Nicholas J, Walker, Marjorie M, Aro, Pertti, Ronkainen, Jukka, Storskrubb, Tom, Hindley, Laura A, Harmsen, W. Scott, Zinsmeister, Alan R, Agréus, Lars
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2007
• Subjects: Adult; Aged; Aged, 80 and over; Biopsy; Diagnosis, Differential; Duodenal Ulcer - diagnosis; Duodenitis - epidemiology; Duodenitis - pathology; Dyspepsia - epidemiology; Dyspepsia - pathology; Endoscopy, Gastrointestinal - methods; Eosinophilia - epidemiology; Eosinophilia - pathology; Eosinophils - pathology; Female; Gastroenterology and Hepatology; Humans; Incidence; Male; Medicin och hälsovetenskap; Middle Aged; Population Surveillance; Retrospective Studies; Severity of Illness Index; Sweden - epidemiology; Sweden; hematoxylin and eosin; major basic protein; OR; CI; H&E; second portion of duodenum; confidence interval; MBP; odds ratio; D1; duodenal bulb; D2
• ISSN: 1542-3565; 1542-7714; 1542-7714
• DOI: 10.1016/j.cgh.2007.05.015

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.