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Duodenal Pathology in Patients with Rumination Syndrome: Duodenal Eosinophilia and Increased Intraepithelial Lymphocytes

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Abstract

Background

Rumination syndrome is a functional gastrointestinal disorder characterized by effortless, postprandial regurgitation. Duodenal eosinophilia has been described in patients with functional dyspepsia. Because of the significant symptomatic overlap between functional dyspepsia and rumination syndrome, we hypothesized that histological changes might exist among patients with rumination syndrome.

Methods

We included patients with rumination syndrome in whom we had obtained duodenal biopsies and compared these with controls. Digital images of biopsy specimens were analyzed for routine pathology and eosinophil counts by a pathologist blinded to the case–control status.

Results

The 22 patients with rumination syndrome had a mean age of 39.2 years (range 21–71) and 77% were female. The 10 controls had a mean age of 34.3 (range 27–69) and 80% were female. There was a significant increase in the mean eosinophil count among the patients with rumination syndrome compared to controls, 26 per mm2 (range 16–42) versus 18 per mm2 (range 10–28), p = 0.006. Intraepithelial lymphocyte counts were significantly higher in rumination patients (mean 15/100 enterocytes, range 8–29) versus controls (mean 11/100 enterocytes, range 11–18), p = 0.02.

Conclusion

Patients with rumination syndrome have subtle duodenal pathology with eosinophilia and increased intraepithelial lymphocyte counts compared to controls.

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Funding

Mayo Career Development Award to Dr. Magnus Halland.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. S.W, Rochester, MN, 55905, USA

    Magnus Halland & Joseph A. Murray

  2. Faculty of Medicine, University of Newcastle, Newcastle, NSW, Australia

    Nicholas J. Talley, Raquel Cameron & Marjorie M. Walker

  3. Macquarie University, Sydney, NSW, Australia

    Mike Jones

Authors
  1. Magnus Halland
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  2. Nicholas J. Talley
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  3. Mike Jones
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  4. Joseph A. Murray
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  5. Raquel Cameron
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  6. Marjorie M. Walker
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Contributions

MH: study design, drafting of manuscript; NJT: study design, drafting of manuscript, critical review of manuscript; MJ: statistical analysis, drafting of manuscript, critical review of manuscript; JM: study design, drafting of manuscript, critical review of manuscript; RC: pathological analysis, drafting and critical review of manuscript; MW: study design, pathological analysis, drafting and critical review of manuscript.

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Correspondence to Magnus Halland.

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Halland, M., Talley, N.J., Jones, M. et al. Duodenal Pathology in Patients with Rumination Syndrome: Duodenal Eosinophilia and Increased Intraepithelial Lymphocytes. Dig Dis Sci 64, 832–837 (2019). https://doi.org/10.1007/s10620-018-5387-7

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  • DOI: https://doi.org/10.1007/s10620-018-5387-7

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