474 Activated Duodenal Eosinophils Are Associated With Early Satiety-Predominant Functional Dyspepsia: Results From a U.S. Veteran Cohort

Abstract

INTRODUCTION: Functional Dyspepsia (FD) is unexplained epigastric discomfort, early satiety or postprandial distress for three months. FD affects 50% of care-seeking Veterans in the United States. Diagnosis of FD is based on Rome consensus symptom criteria as no objective markers exist. There is interest in duodenal eosinophilia as a driver of FD symptoms, however heterogeneity among recent studies has produced divergent results. A “normal” range of duodenal eosinophil counts should be established. The influences of a personal history of atopy, medication use and seasonal variation effects on duodenal eosinophil counts and their relation to FD symptoms are poorly studied. METHODS: This is a cross-sectional study from the Michael E. DeBakey VA Medical Center in Houston, Texas utilizing a well described cohort. Exclusion criteria included malignancy, H. pylori, celiac disease, parasite infection, eosinophilic gastroesophagitis and others. FD was defined by survey-derived Rome II symptom criteria. Medication use was obtained through chart review. Histopathology was independently reviewed by two blinded observers. RESULTS: 460 patients were included in the present study. There was good observer agreement on duodenal eosinophil counts. Duodenal eosinophilia was defined as ≥62 per 5 HPF. Patient characteristics grouped by presence or absence of duodenal eosinophilia are found in Table 1. Mean eosinophil counts grouped by various items are included in Table 2. 182 patients had FD (39.6%) and were younger (58 vs 60.2 years of age, P = 0.01) and more likely to be on a PPI and H2RA (P = 0.03, P = 0.02) compared to controls. Eosinophil degranulation was present in 101 (22.0%) patients and was associated with FD (OR 1.84, 95% CI 1.15-2.94, P = 0.01), specifically early satiety symptoms (OR 2.15, 95% CI 1.33-3.47, P = 0.002) but not epigastric pain (P = 0.62). Samples collected in the fall had significantly lower mean duodenal eosinophils per 5 HPF (55.1) than those collected in the spring (82), summer (73.2), or winter (76.2) months. CONCLUSION: In this large, adult, and diverse VA study, duodenal eosinophilia, defined as counts ≥62 per 5 HPF, was common (50.2%). While we could not confirm an association between duodenal eosinophilia and FD in our patient cohort, a positive association between the presence of activated duodenal eosinophils and FD, specifically early satiety-predominant FD, was found. This supports the inflammatory hypothesis of FD, albeit more proximally in the cascade.