Non-ulcer dyspepsia and duodenal eosinophilia: an adult endoscopic population-based case-control study.
OBJECTIVE
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.
Talley
Nicholas J
NJ
Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Walker
Marjorie M
MM
Aro
Pertti
P
Ronkainen
Jukka
J
Storskrubb
Tom
T
Hindley
Laura A
LA
Harmsen
W Scott
WS
Zinsmeister
Alan R
AR
Agréus
Lars
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003937:Diagnosis, Differential; D004381:Duodenal Ulcer / Q000175:diagnosis; D004382:Duodenitis / Q000453:epidemiology / Q000473:pathology*; D004415:Dyspepsia / Q000453:epidemiology / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004802:Eosinophilia / Q000453:epidemiology / Q000473:pathology*; D004804:Eosinophils / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology