Activated Duodenal Mucosal Eosinophils in Children With Dyspepsia: A Pilot Transmission Electron Microscopic Study

Friesen, Craig A.; Andre, Linda; Garola, Robert E.; Hodge, Charles; Roberts, Charles S.

doi:10.1097/00005176-200209000-00017

Cited by 47 publications

(45 citation statements)

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“…The degree of degranulation for antral eosinophils was moderate (20-60%) in 42% and extensive ([60%) in 54% of patients. These rates are similar to our previously reported findings for duodenal eosinophils in functional dyspepsia and also to rates reported for other diseases where eosinophils are believed to have a pathogenic role [9,32]. In the current study, mast cells also showed frequent evidence of activation, with degranulation greater than 50% in 81% of the patients.…”

Section: Discussionsupporting

confidence: 92%

“…Talley et al found increased duodenal eosinophils, but not gastric eosinophils, in adults with dyspepsia [8]. We have previously reported significant degranulation of duodenal eosinophils on electron microscopy (EM) in children and adolescents with functional dyspepsia [9]. To our knowledge, however, the activation state of gastric eosinophils or mast cells has not been evaluated in functional dyspepsia.…”

Section: Introductionmentioning

confidence: 93%

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Antral Inflammatory Cells, Gastric Emptying, and Electrogastrography in Pediatric Functional Dyspepsia

et al. 2008

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The aims of the current study were to determine the activation states of antral eosinophils and mast cells and to evaluate the interactions of antral inflammatory cells with gastric emptying and electrogastrography (EGG) in 30 pediatric patients with functional dyspepsia. Eosinophil degranulation was moderate in 42% and extensive in 54% of patients. Mast cell degranulation was > 50% in 81% of patients. Elevated mast cell density was associated with slower one hour gastric emptying and increased preprandial dysrhythmia. Mast cell density correlated with the preprandial percentage tachygastria. CD3+ cell density correlated with the preprandial percentage tachygastria also, but only in patients with increased eosinophil density. In conclusion, antral eosinophils and mast cells are significantly activated in pediatric functional dyspepsia. Mast cell density is associated with delayed gastric emptying and preprandial dysrhythmia, suggesting that there may be an interaction between antral inflammation and gastric electromechanical dysfunction in the pathophysiology of pediatric functional dyspepsia.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 93%

Antral Inflammatory Cells, Gastric Emptying, and Electrogastrography in Pediatric Functional Dyspepsia

et al. 2008

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“…This was observed in a moderate to extensive degree in 95% of 20 children with dyspepsia [17]. Duodenal mucosal eosinophilia was also shown in 71% of children undergoing endoscopy with mucosal biopsy for dyspepsia and treatment with ranitidine and hydroxyzine, followed with cromolyn if there was no pain relief, showing a 90% response in an uncontrolled observational study [14].…”

Section: Functional Dyspepsia Eosinophils and Mast Cellsmentioning

confidence: 97%

The Role of Eosinophils and Mast Cells in Intestinal Functional Disease

Walker

Warwick

Ung

et al. 2011

Curr Gastroenterol Rep

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Functional gastrointestinal disorders (FGIDs) are common and currently defined by a symptom-based classification with no discernable pathology. In functional dyspepsia (FD), the duodenum is now implicated as a key area where symptoms originate.This is attributed to immune activation with increasing evidence indicating a role for duodenal eosinophilia. In irritable bowel syndrome (IBS), mastocytosis has been documented throughout the small and large intestine. Eosinophils and mast cells are an important link between innate and adaptive immunity, and are important in allergic type TH2 inflammation. Eosinophils may give rise to symptoms due to release of preformed cytokine proteins, which trigger neural excitation, muscle spasm, and pain. The close relationship of mast cells to nerves in IBS may similarly give rise to symptoms. Genetic studies also support of the role of innate immunity in FGIDs. The data supporting a prime role for eosinophils and mast cells in subsets of FD and IBS has become credible, and these data should be used to implement advances in diagnosis and therapeutic trials.

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“…It is unclear whether it is the number of eosinophils or the percentage of activation that actually leads to dyspeptic symptoms. Friesen et al [70] found that eosinophils present in duodenal mucosa of children with dyspepsia were activated in a significant proportion of patients, even children with normal eosinophil counts. Therefore, the degree of degranulation may actually be the "pathogen" in this case.…”

Section: Montelukastmentioning

confidence: 99%

Dyspepsia in childhood and adolescence: Insights and treatment considerations

Pérez

Youssef

2007

Curr Gastroenterol Rep

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Functional dyspepsia (FD) is common in children, with as many as 80% of those being evaluated for chronic abdominal pain reporting symptoms of epigastric discomfort, nausea, or fullness. It is known that patients with persistent complaints have increased comorbidities such as depression and anxiety. The interaction with psychopathologic variables has been found to mediate the association between upper abdominal pain and gastric hypersensitivity. These observations suggest that abnormal central nervous system processing of gastric stimuli may be a relevant pathophysiologic mechanism in FD. Despite increased understanding, no specific therapy has emerged; however, recent nonpharmacological-based options such as hypnosis may be effective. Novel approaches, including dietary manipulation and use of nutraceuticals such as ginger and Iberogast (Medical Futures Inc., Ontario, Canada), may also be considered.

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Activated Duodenal Mucosal Eosinophils in Children With Dyspepsia: A Pilot Transmission Electron Microscopic Study

Abstract: Eosinophils present in the duodenal mucosa of children with dyspepsia are activated in a significant proportion of patients, even in those with normal eosinophil counts. The degree of degranulation is similar to that seen in other conditions where eosinophils have a pathogenic role.

Cited by 47 publications

References 28 publications

Antral Inflammatory Cells, Gastric Emptying, and Electrogastrography in Pediatric Functional Dyspepsia

Antral Inflammatory Cells, Gastric Emptying, and Electrogastrography in Pediatric Functional Dyspepsia

The Role of Eosinophils and Mast Cells in Intestinal Functional Disease

Dyspepsia in childhood and adolescence: Insights and treatment considerations

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