A cross-sectional study of nausea in functional abdominal pain: relation to mucosal mast cells and psychological functioning

Abstract

Background Nausea is a common symptom in youth with chronic abdominal pain. The aims of the current study were to assess: 1) the frequency of nausea in patients with functional dyspepsia (FD) and irritable bowel syndrome (IBS), respectively, as defined by Rome IV criteria; and, 2) relationships between nausea and mucosal inflammation as defined by antral and duodenal eosinophil and mast cell densities. A secondary aim was to assess relationships between nausea and other gastrointestinal symptoms, non-gastrointestinal somatic symptoms, and psychological dysfunction. Methods Records from patients with pain associated functional gastrointestinal disorders were retrospectively reviewed for gastrointestinal and somatic symptoms and anxiety, depression, and somatizations scores as assessed by the Behavior Assessment System for Children (BASC-2). In addition, previous gastric and mucosal biopsies were assessed for mast cell and eosinophil densities, respectively. Results 250 patients, ages 8 to 17 years, were assessed. Nausea was reported by 78% and was equally prevalent in those with FD alone, those with IBS alone, and those with both FD and IBS. Nausea was associated with increased mean (21.4 vs. 17.5) and peak (26.2 vs. 22.9) duodenal mast cell densities as compared those without nausea. Nausea was also associated with a wide variety of individual gastrointestinal symptoms, as well as headaches, fatigue, and dizziness. Lastly, nausea was associated with elevated self-report scores for anxiety (55.2 vs. 50.0), depression (50.2 vs. 46.1), and somatization (70.3 vs. 61.8). Conclusions Nausea is common in children and adolescents with pain-associated FGIDs as defined by Rome IV and is not unique to either FD or IBS. Nausea is associated with increased mucosal mast cell density, non-gastrointestinal somatic symptoms, and psychologic dysfunction.

Vagal gut-brain signaling mediates amygdaloid plasticity, affect, and pain in a functional dyspepsia model

“…We therefore hypothesized that increased gastric vagal activity may contribute to the changes in affective behavior and nociception associated with FD, and that gastric mast cells may have a mechanistic role, given their well-established functional relationship with neurons (14). Several studies have reported an increase in mucosal mast cells in the upper gastrointestinal tract in both children and adults with FD, similar to what has been described in patients with IBS (15)(16)(17). In the current study, we tested these hypotheses using a previously validated rat model of FD in which mild gastric irritation in neonatal rats induces a state of persistent gastric hyperalgesia, impaired gastric motility, and anxiety-like and depression-like behavior in adulthood, which was associated with brain alterations (7,18).…”

An Update on the Assessment and Management of Pediatric Abdominal Pain

“…Nausea has been associated with worse abdominal pain and gastrointestinal symptoms, somatic symptoms, sleep disturbances, depression, anxiety, disability, poor school and social functioning, school absences, and poorer QOL. [14][15][16][17] Nausea also predicts a higher rate of persistence of gastrointestinal and somatic symptoms, anxiety, and depression into adulthood. 14 As such, nausea may be an important treatment target in FAPDs.…”

Description of the normal gastric mucosa in anatomy education: How many leukocytes are acceptable?

“…As the role of mast cells in the pathology of gastrointestinal disease is still evolving, there are currently no specific criteria for their number in the normal stomach (Doyle et al, 2014; Ramsay et al, 2010; Zanelli et al, 2021). Quantification of mast cells in the healthy gastric mucosa reveals a wide range from fewer than 15 to more than 50 per HPF (Friesen et al, 2020, 2021; Hahn & Hornick, 2007; Jakate et al, 2006; Siegert et al, 2004), which makes it difficult to specify a cut‐off value for differentiating normal from pathological mucosa. In systemic mastocytosis, mast cells are often found in confluent sheets and aggregates of over 100 cells per HPF (Ramsay et al, 2010).…”

“…Quantification of mast cells in the healthy gastric mucosa reveals a wide range from fewer than 15 to more than 50 per HPF (Friesen et al, 2020(Friesen et al, , 2021Hahn & Hornick, 2007;Jakate et al, 2006;Siegert et al, 2004), which makes it difficult to specify a cut-off value for differentiating normal from pathological mucosa. In systemic mastocytosis, mast cells are often found in confluent sheets and aggregates of over 100 cells per HPF (Ramsay et al, 2010).…”