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Functional Dyspepsia and Duodenal Eosinophil Count and Degranulation: A Multiethnic US Veteran Cohort Study

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Abstract

Background

Duodenal eosinophilia may play a role in functional dyspepsia (FD), but existing study results are conflicted. We investigated the association between duodenal eosinophils (count and degranulation) and FD symptoms, accounting for atopic conditions, medications, and seasonal variations.

Methods

In a cross-sectional study conducted in the Michael E. DeBakey VA Medical Center in Houston, Texas, we analyzed duodenal histopathology of 436 patient samples from a prospective cohort with a validated symptom survey data and chart reviews. FD was defined using Rome II symptom criteria. Eosinophil count was number per 5 high-power fields (HPF), and eosinophil degranulation was eosinophilic granules in the stroma both determined by two independent investigators.

Results

The study cohort was predominantly male (87.4%) with a mean age of 59.3 (standard deviation (SD) ± 9.8). Mean and median eosinophil counts were 75.5 (± 47.8) and 63 (IQR: 43, 101) per five HPF, respectively. Duodenal eosinophilia (defined as ≥ 63 per 5 HPF) and eosinophil degranulation were present in 50.5% and 23.1% of patient samples, respectively. FD was observed in 178 patients (41.7%), but neither the mean eosinophil count nor duodenal eosinophilia was associated with FD. Eosinophil degranulation was independently associated with FD overall (OR 1.74; 95% CI 1.08, 2.78; p = 0.02) and early satiety (OR 2.04; 95% CI 1.26, 3.30; p = 0.004).

Conclusions

In this large, ethnically diverse cohort of adult patients, we found no significant association between duodenal eosinophilia and FD. However, the presence of duodenal eosinophilic degranulation, an activated eosinophil marker, was significantly associated with FD, especially early satiety.

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Funding

SCAHN VISN 16 pilot grant.

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Authors and Affiliations

  1. Department of Medicine at Baylor College of Medicine, Houston, TX, USA

    M. Ellionore Järbrink-Sehgal, Jordan Sparkman, David Y. Graham & Hashem E. El-Serag

  2. Michael E DeBakey VA Medical Center, Houston, TX, USA

    M. Ellionore Järbrink-Sehgal, Linda K. Green, Daniel G. Rosen, David Y. Graham & Hashem E. El-Serag

  3. Department of Pathology at Ameripath Southwest, Fort Myers, FL, USA

    Alexander Damron

  4. Department of Pathology at Baylor College of Medicine, Houston, TX, USA

    Alexander Damron, Linda K. Green, Daniel G. Rosen & David Y. Graham

  5. Department of Pathology, University of Newcastle, Newcastle, Australia

    Marjorie M. Walker

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  1. M. Ellionore Järbrink-Sehgal
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  2. Jordan Sparkman
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  3. Alexander Damron
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  4. Marjorie M. Walker
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  8. Hashem E. El-Serag
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Contributions

JS, M.D.; AD, M.D.; MMW, BMedSci, BMBS, FRCPath, FRCPA; LKG, M.D.; DGR, M.D.; DYG, M.D.; HEES, M.D., M.P.H., were involved in critical revision of manuscript. MEJS, M.D., Ph.D., and HEES M.D., M.P.H., were involved in study idea and hypothesis. MEJS, M.D., Ph.D.; JS, M.D.; AD, M.D.; LKG, M.D., collected the data. MEJS, M.D., Ph.D., was involved in statistical analyses, interpretation of data and drafting of the manuscript.

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Correspondence to Hashem E. El-Serag.

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Järbrink-Sehgal, M.E., Sparkman, J., Damron, A. et al. Functional Dyspepsia and Duodenal Eosinophil Count and Degranulation: A Multiethnic US Veteran Cohort Study. Dig Dis Sci 66, 3482–3489 (2021). https://doi.org/10.1007/s10620-020-06689-2

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  • DOI: https://doi.org/10.1007/s10620-020-06689-2

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