Digestive Diseases and Sciences

, Volume 53, Issue 10, pp 2634–2640 | Cite as

Antral Inflammatory Cells, Gastric Emptying, and Electrogastrography in Pediatric Functional Dyspepsia

  • Craig A. Friesen
  • Zhiyue Lin
  • Meenal Singh
  • Vivekanand Singh
  • Jennifer V. Schurman
  • Nanci Burchell
  • Jose T. Cocjin
  • Richard W. McCallum
Original Paper


The aims of the current study were to determine the activation states of antral eosinophils and mast cells and to evaluate the interactions of antral inflammatory cells with gastric emptying and electrogastrography (EGG) in 30 pediatric patients with functional dyspepsia. Eosinophil degranulation was moderate in 42% and extensive in 54% of patients. Mast cell degranulation was >50% in 81% of patients. Elevated mast cell density was associated with slower one hour gastric emptying and increased preprandial dysrhythmia. Mast cell density correlated with the preprandial percentage tachygastria. CD3+ cell density correlated with the preprandial percentage tachygastria also, but only in patients with increased eosinophil density. In conclusion, antral eosinophils and mast cells are significantly activated in pediatric functional dyspepsia. Mast cell density is associated with delayed gastric emptying and preprandial dysrhythmia, suggesting that there may be an interaction between antral inflammation and gastric electromechanical dysfunction in the pathophysiology of pediatric functional dyspepsia.


Functional dyspepsia Eosinophils Mast cells Gastric emptying Electrogastrography 


  1. 1.
    Rasquin A, DiLorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, Walker LS (2006) Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 130:1527–1537PubMedCrossRefGoogle Scholar
  2. 2.
    Hyams JS, Davis P, Sylvester FA, Zeiter DK, Justinich CJ, Lerer T (2000) Dyspepsia in children and adolescents: a prospective study. J Pediatr Gastroenterol Nutr 30:413–418PubMedCrossRefGoogle Scholar
  3. 3.
    Schurman JV, Friesen CA, Danda CE, Andre L, Welchert E, Lavenbarg T, Cocjin JT, Hyman PE (2005) Diagnosing functional abdominal pain with the Rome II criteria: Parent, child, and clinician agreement. J Pediatr Gastroenterol Nutr 41:291–295PubMedCrossRefGoogle Scholar
  4. 4.
    Tack J, Bisschops R, Sarnelli G (2004) Pathophysiology and treatment of functional dyspepsia. Gastroenterology 127:1239–1255PubMedCrossRefGoogle Scholar
  5. 5.
    Talley NJ, Vakil NB, Moayyedi P (2005) American Gastroenterological Association technical review on the evaluation of dyspepsia. Gastroenterology 129:1756–1780PubMedCrossRefGoogle Scholar
  6. 6.
    Grundy D, Al-Chaer ED, Aziz Q, Collins SM, Ke M, Tache Y, Wood JD (2006) Fundamentals of neurogastroenterology: basic science. Gastroenterology 130:1391–1411PubMedCrossRefGoogle Scholar
  7. 7.
    Hall W, Buckley M, Crotty P, O’Morain CA (2003) Gastric mucosal mast cells are increased in Helicobacter pylori-negative functional dyspepsia. Clin Gastroenterol Hepatol 1:363–369PubMedCrossRefGoogle Scholar
  8. 8.
    Talley NJ, Walker MM, Aro P, Ronkainen JA, Storskrubb T, Hindley LA, Pennaneach C, Harmsen WS, Zinsmeister AR, Agreus L (2007) Duodenal eosinophilia and mast cell infiltration in functional dyspepsia (FD) and irritable bowel syndrome (IBS): Duodenal eosinophilia a biomarker for FD, but not IBS in adults? Gastroenterology 132:A–73Google Scholar
  9. 9.
    Friesen CA, Andre L, Garola R, Hodge C, Roberts C (2002) Activated duodenal mucosal eosinophils in children with dyspepsia: a pilot transmission electron microscopic study. J Pediatr Gastroenterol Nutr 35:329–333PubMedCrossRefGoogle Scholar
  10. 10.
    Barbara G, Stanghellini V, DeGiorgio R, Corinaldesi R (2006) Functional gastrointestinal disorders and mast cells: implications for therapy. Neuogastroenterol Motil 18:6–17CrossRefGoogle Scholar
  11. 11.
    Friesen CA, Schurman JV, Qadeer A, Andre L, Welchert E, Cocjin J (2005) Relationship between mucosal eosinophils and anxiety in pediatric dyspepsia. Gastroenterology 129:A–158Google Scholar
  12. 12.
    Riezzo G, Chiloiro M, Guerra V, Borrelli O, Salvia G, CUcchiara S (2000) Comparison of gastric electrical activity and gastric emptying in healthy and dyspeptic children. Dig Dis Sci 45:517–524PubMedCrossRefGoogle Scholar
  13. 13.
    Friesen CA, Lin Z, Garola R, Andre L, Burchell N, Moore A, Roberts CC, McCallum RW (2005) Chronic gastritis is not associated with gastric dysrhythmia or delayed solid emptying in children with dyspepsia. Dig Dis Sci 50:1012–1018PubMedCrossRefGoogle Scholar
  14. 14.
    Friesen CA, Lin Z, Hyman PE, Andre L, Welchert E, Schurman JV, Cocjin JT, Burchell N, Pulliam S, Moore A, Lavenbarg T, McCallum RW (2006) Electogastrography in pediatric functional dyspepsia: relationship to gastric emptying and symptom severity. J Pediatr Gastroenterol Nutr 42:265–269PubMedCrossRefGoogle Scholar
  15. 15.
    Chitkara DK, Camilleri M, Zinsmeister AR, Burton D, El-Youssef M, Freese D, Walker L, Stephens D (2005) Gastric sensory and motor dysfunction in adolescents with functional dyspepsia. J Pediatr 146:500–505PubMedCrossRefGoogle Scholar
  16. 16.
    Pytrus T, Iwanczak B (2001) The value of electrogastrography in children with functional gastrointestinal disorders. J Pediatr Gastroenterol Nutr 32(Suppl 1):S49Google Scholar
  17. 17.
    Hoffman I, Vos R, Tack J (2007) Assessment of gastric sensorimotor function in pediatric patients with unexplained dyspeptic symptoms and poor weight gain. Neurogastroenterol Motil 19:173–179PubMedCrossRefGoogle Scholar
  18. 18.
    Lin Z, Chen JDZ, Parolisi S, Shifflett J, Peura DA, McCallum RW (2001) Prevalence of gastric myoelectrical abnormalities in patients with nonulcer dyspepsia and H. pylori infection. Resolution after H. pylori eradication. Dig Dis Sci 46:739–745PubMedCrossRefGoogle Scholar
  19. 19.
    Miyaji H, Azuma T, Ito S, Abe Y, Ono H, Suto H, Ito Y, Yamazaki Y, Kohli Y, Kuriyama M (1999) The effect of Helicobacter pylori eradication therapy on gastric antral myoelectrical activity and gastric emptying in patients with non-ulcer dyspepsia. Aliment Pharmacol Ther 13:1473–1480PubMedCrossRefGoogle Scholar
  20. 20.
    Perri F, Pastore M, Zicolella A, Annese V, Quitadamo M, Andriulli A (2000) Gastric emptying of solids is delayed in celiac disease and normalitizes after gluten withdrawal. Acta Paediatr 89:921–925PubMedCrossRefGoogle Scholar
  21. 21.
    Strobel S, Busuttil A, Ferguson A (1983) Human intestinal mucosal mast cells: expanded population in untreated celiac disease. Gut 24:222–227PubMedCrossRefGoogle Scholar
  22. 22.
    Colombel JF, Torpier G, Janin A, Klein O, Cortot A, Capron M (1992) Activated eosinophils in adults with celiac disease: evidence for a local release of major basic protein. Gut 33:1190–1194PubMedCrossRefGoogle Scholar
  23. 23.
    Ravelli AM, Tobanelli P, Volpi S, Ugazio AG (2001) Vomiting and gastric motility in infants with cow’s milk allergy. J Pediatr Gastroenterol Nutr 32:59–64PubMedCrossRefGoogle Scholar
  24. 24.
    Catto-Smith AG, Patrick MK, Scott RB, Davison JS, Gall DG (1989) Gastric response to mucosal IgE-mediated reactors. Am J Physiol 257(5 Pt 1):G704–G708PubMedGoogle Scholar
  25. 25.
    Tache Y, Perdue MH (2004) Role of peripheral CRF signaling pathways in stress-related alterations of gut motility and mucosal function. Neurogastroenterol Motil 16(Suppl 1):137–142PubMedCrossRefGoogle Scholar
  26. 26.
    Monnikes H, Tebbe JJ, Hildebrandt M, Arck P, Osmanoglou E, Rose M, Klapp B, Wiedenmann B, Heymann-Monnikes I (2001) Role of stress in functional gastrointestinal disorders. Evidence for stress-induced alterations in gastrointestinal motility and sensitivity. Dig Dis Sci 19:201–211CrossRefGoogle Scholar
  27. 27.
    Hou X-H, Zhu L-R, Li Q-X, Chen JDZ (2001) Alterations in mast cells and 5HT-positive cells in gastric mucosa in functional dyspepsia patients with hypersensitivity. Neurogastroenterol Motil 13:398–399Google Scholar
  28. 28.
    Chen JDZ, McCallum RW (1994) Electrogastrographic parameters and their clinical significance. In: Chen JDZ, McCallum RW (eds) Electrogastrography: principles and applications. Raven, New York, pp 45–73Google Scholar
  29. 29.
    Matter SE, Bhatia PS, Miner PB Jr (1990) Evaluation of antral mast cells in nonulcer dyspepsia. Kig Kis Sci 35:1358–1363Google Scholar
  30. 30.
    Whitington PF, Whitington GL (1988) Eosinophilic gastroenteropathy in childhood. J Pediatr Gastroenterol Nutr 7:379–385PubMedCrossRefGoogle Scholar
  31. 31.
    Liacouras CA (2007) Eosinophilic gastrointestinal disorders. Pract Gastroenterol XXXI:53–67Google Scholar
  32. 32.
    Erjefalt JS, Greiff L, Andersson M, Adelroth E, Jeffery PK, Persson CGA (2001) Degranulation pattern of eosinophil granulocytes as determinants of eosinophil driven disease. Thorax 56:341–344PubMedCrossRefGoogle Scholar
  33. 33.
    Drake-Lee AB, Price J (1991) Ultrastructure of nasal mast cells in normal subjects and patients with perennial allergic rhinitis. J Laryngol Otol 105:1006–1013PubMedGoogle Scholar
  34. 34.
    Shahana S, Bjornsson E, Ludriksdottir D, Janson C, Nettelbladt O, Venge P, Roomans GM (2005) Ultrastructure of bronchial biopsies from patients with allergic and non-allergic asthma. Respir Med 99:429–443PubMedCrossRefGoogle Scholar
  35. 35.
    Kirsch R, Bokhary R, Marcon MA, Cutz E (2007) Activated mucosal mast cells differentiate eosinophilic (allergic) esophagitis from gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr 44:20–26PubMedCrossRefGoogle Scholar
  36. 36.
    Park CH, Joo YE, Choi SK, Rew JS, Kim SJ, Lee MC (2003) Activated mast cells infiltrate in close proximity to enteric nerves in diarrhea-predominant irritable bowel syndrome. J Korean Med Sci 18:204–210PubMedGoogle Scholar
  37. 37.
    Barbara G, Stanghellini V, De Giorgio R, Cremon C, Cottrell GS, Santini D, Pasquinelli G, Morselli-Labate AM, Grady EF, Bunnett NW, Collins SM, Corinaldesi R (2004) Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology 126:693–702PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Craig A. Friesen
    • 1
  • Zhiyue Lin
    • 2
  • Meenal Singh
    • 1
  • Vivekanand Singh
    • 3
  • Jennifer V. Schurman
    • 4
  • Nanci Burchell
    • 5
  • Jose T. Cocjin
    • 1
  • Richard W. McCallum
    • 2
  1. 1.Section of GastroenterologyThe Children’s Mercy Hospital and ClinicsKansas CityUSA
  2. 2.Department of MedicineThe University of Kansas Medical CenterKansas CityUSA
  3. 3.Section of PathologyThe Children’s Mercy Hospital and ClinicsKansas CityUSA
  4. 4.Section of Developmental and Behavioral SciencesThe Children’s Mercy Hospital and ClinicsKansas CityUSA
  5. 5.Section of RadiologyThe Children’s Mercy Hospital and ClinicsKansas CityUSA

Personalised recommendations