Multicentric observational study to determine duodenal histological characteristics in patients with functional dyspepsia

Abstract

Functional dyspepsia (FD) is a highly prevalent disorder, classified according to the Rome criteria in: postprandial distress (PPDS) and epigastric pain syndrome (EPS). In the last decade, the concept of FD has begun to change with new data on pathogenic mechanisms, one of the most important findings has been the association of duodenal inflammation with FD. The duodenal mucosa was characterized by an increase in eosinophils, mast cells and impaired permeability. These suggests that duodenal inflammation is an important feature in FD. In view of these findings, our aim was to analyzed FD subtypes with duodenal histological characteristics in northeastern Argentina. The study was carried out from 01/14-02/19. Were evaluated 312 patients with FD who underwent gastroscopy, gastric (body and antrum) and duodenum (D2) biopsies were taken. The gastric samples were evaluated with the HE and Giemsa staining. In Duodenum samples, eosinophil count (D-Eo) and intraepithelial lymphocytes (D-ILy) were determined by HE, D-Eo were expressed semiquantitatively: 0, <10, ≥10- <20, ≥20 per field. Of the 312 patients 53 were excluded (49 peptic ulcer, 3 celiac disease and 1 gastric cancer), 259 subjects were analyzed. Mean age 49 years (95% CI 47-51), 56% female, BMI of 26.6 kg/m2 (95% CI 26.1-27.1), diabetes 20% and smokers 25%, Hp positive were 172 (66%). FD-subtype were: PPDS 88 (34%), EPS 107 (41%) and overlap (PPDS/EPS) in 65 (25%). Hp was determined in the FD-subtypes, the presence of Hp was significantly associated with EPS (Hp-pos: 89 vs Hp-neg: 18, OR: 4.003 95% CI 2.2-7.3, p <0, 0001), no differences were observed in the overlap group, and the absence of Hp was significantly higher in the DPP group (Hp-pos + 35 vs Hp-neg 53, OR: 0.1597 95% CI 0.09-0, 3, p <0.0001). No differences in D-Eo and D-ILy count were observed in Hp-positive Vs Hp-negative patients. Likewise, no differences in D-ILy were observed between the DF subtypes. An increase in the D-Eo count was observed in the PPDS group, being significant among subtypes of dyspepsia when D-Eo ≥10 (DPP vs. Non-DPP, OR: 2.34 95% CI 1.34-4.08, p: 0.009). Then, multivariate analysis to evaluate subtypes of FD (ED and DPP) and clinical/histological variables was performed. Hp-positive was the only independent variable associated with EPS (OR 4.21 95% CI 2.26-7.85), where in PPDS the increase in D-Eo was the only variable significantly associated (D-Eo: OR 2.63 95% CI 1.66-4.18). Conclusions: 1) in our cohort, the EPS subtype was the most frequent and correlated with the presence of Hp+ but not with the D-Eo or D-ILy count, 2) the PPDS subtype had an association with duodenal eosinophilia independent of Hp. 3) These results provide epidemiological data on the FD-subtype and pathogenic role of Hp and duodenal eosinophilia, which could potentially optimize the diagnostic and therapeutic approach in the future