Clinical Profile and Spectrum of Duodenal Biopsy and other Investigational Abnormalities in NUD Patients

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Aim of Study: The study was done to find out the prevalence of rapid urease test (RUT) positivity, IgA-tTG, and spectrum of duodenal abnormalities in nonulcer dyspepsia (NUD) patients. Methods: This descriptive observational study was carried out in the gastroenterology center in GOI research institute from August 2020 to March 2021. Initially, 200 dyspepsia patients were selected. Fifty patients were excluded due to various reasons. Finally, 150 patients who met the Rome 4 criteria for NUD/functional dyspepsia were recruited. The inclusion criteria were patients above 18 years of age, dyspepsia for ≥ Six months, and no evidence of underlying malignancy, pan gastritis, previous gastric ulcers, and pancreatitis. The patients underwent RUT, upper gastrointestinal endoscopy, duodenal biopsy, and serum IgA-tTG antibody. Results: The mean age was 46.3 years ± 14.12 years, of which 49.3% were female and 50.70% were male. The prevalence of epigastric pain syndrome (EPS) was found in 37.3%, postprandial distress syndrome (PDS) in 30.7%, and both EPS + PDS in 32%. Thirty-eight percent of the NUD patients were positive on RUT suggesting Helicobacter pylori infection. 88.7% of the NUD patients were IgA-tTG antibody negative and 11.3% serologically positive. The duodenal biopsy was normal in 48% of the patients, 21.3% had mild inflammation/duodenitis, 8% had chronic duodenitis, and 22.7% had various grades of celiac disease (CeD) (as per Marsh grading). These 22.7% showing evidence of CeD on histopathological examination showed Marsh Grade 1 in 12.7%, Grade 2 in 2%, Grade 3A in 6.7%, and Grade 3B in 1.3%. Only 17.6% of biopsy positive had IgA-tTG antibody positivity, but only 4% of the total cases were positive for both biopsy and IgA-tTG antibody (P = 0.05). Eosinophilic infiltration in the duodenum was common in NUD patients. It was observed that 17.33% (26/150) of the NUD patients had duodenal eosinophilia. Duodenal eosinophilia association with various other Gastrointestinal disorders, It was observed that 33.33%(19/57) of the H. pylori patients had duodenal eosinophilia with p<0.001. It was also observed that 7.52% (7/93) of others, such as normal individuals, chronic duodenitis, and mild inflammation/duodenitis, had duodenal eosinophilia. Conclusion: The prevalence of H. pylori and IgA-tTG antibodies in NUD patients was 38% and 11.3%, respectively. The spectrum of duodenum biopsy abnormalities in NUD patients included mild inflammation/duodenitis, chronic duodenitis, and CeD. 22.7% of the NUD patients had various degrees of CeD morphology on D2 biopsy, and only 17.6% of these biopsy-positive patients were positive for IgA-tTG. Only 4% of the total NUD patients were positive for both biopsy and IgA-tTG antibody labeled as CeD. There is a significant association between H. pylori and duodenal eosinophilia.