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

Yang

J Neurogastroenterol Motil

2016

Background/AimsAbdominal pain-related functional gastrointestinal disorder (AP-FGID) is common in children and adults. However, the mechanism of AP-FGID is not clearly known. Recently, micro-inflammation, especially eosinophilia in the gastrointestinal tract, was suggested in the pathophysiology of AP-FGID in adults. The aim of this study was to evaluate the association of gastric and duodenal eosinophilia with pediatric AP-FGID. MethodsIn total, 105 pediatric patients with AP-FGID were recruited and classified into 4 subgroups based on the Rome III criteria. Eosinophil counts in the gastric and duodenal tissues of children with AP-FGID were compared to those from normal pathology references or those of children with Helicobacter pylori infection. Tissue eosinophil counts were also compared among the 4 subtypes of AP-FGID. ResultsEosinophil counts in the gastric antrum and body were significantly higher in children with AP-FGID than normal reference values. Duodenal eosinophil counts were higher in children with AP-FGID, but not significantly when compared with normal reference values. There were no significant differences in eosinophil counts of the stomach or duodenum among the 4 subtypes of AP-FGID. Eosinophils counts in the gastric antrum and body were significantly higher in children with H. pylori infection than in those with AP-FGID. Duodenal eosinophilia was prominent in cases of H. pylori infection, but not statistically significant when compared with AP-FGID. ConclusionsOur study revealed that gastric eosinophilia is associated with AP-FGID in children, regardless of the subtype of functional abdominal pain. This suggests some contribution of gastrointestinal eosinophils in the development of pediatric AP-FGID.

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Analysis of Gastric and Duodenal Eosinophils in Children with Abdominal Pain Related Functional Gastrointestinal Disorders According to Rome III Criteria

Yang

J Neurogastroenterol Motil

2016

J Neurogastroenterol Motil

“…Few papers show that the gastric and duodenal eosinophil density was increased in children with functional GI disorders. 4,5 This article showed similar results in pediatric patients with functional GI disorders, however, the diagnosis was based on the Rome III criteria, and excluded food allergy, asthma, atropic dermatitis, and rhinitis before the diagnosis. H. pylori infection group showed high eosinophils in the stomach and duodenum, but no statistical significance.…”

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confidence: 74%

The Gastric and Duodenal Eosinophilia in Functional Dyspepsia

Kim

2016

Functional dyspepsia (FD) is a common functional gastrointestinal (GI) disorder (1 in 10 people), and a chronic clinical syndrome associated with postprandial fullness, early satiation, epigastric burning, or epigastric pain. As valid clinical entities postprandial distress syndrome and epigastric pain syndrome are accepted. 1 The pathogenesis of FD still remains to be established. However, many data suggest that environmental (inflections including Helicobacter pylori and diet), physiologic (acid, gastric accommodation, gastric emptying, and duodenal sensitivity), psychologic (anxiety, depression, and brain pain modulating circuits), and biologic (genes, cytokines, and duodenal eosinophilia) factors may play a role in the pathophysiology of FD. 1 The role of eosinophilia in functional dyspepsia is not well established. It was hypothesized that eosinophils secondary to duodenal acid or food allergy accumulates in some patients with FD, and degranulate by the release of injured materials. 2 Also, eosinophilia in the stomach and duodenum is a secondary response to chronic inflammation by H. pylori infection.In the original article of the Journal of Neurogastroenterology and Motility, Lee EH et al 3 described the relationship between gastroduodenal eosinophils and pediatric functional GI disorders. Few papers show that the gastric and duodenal eosinophil density was increased in children with functional GI disorders. 4,5 This article showed similar results in pediatric patients with functional GI disorders, however, the diagnosis was based on the Rome III criteria, and excluded food allergy, asthma, atropic dermatitis, and rhinitis before the diagnosis. H. pylori infection group showed high eosinophils in the stomach and duodenum, but no statistical significance.In summary, the gastric and duodenal eosinophilia versus the clinical symptoms of pediatric FD are not as yet clearly correlated. The paper by Lee EH et al 3 showed the possibility of correlation between eosinophils in the stomach and duodenal biopsy specimens, and the clinically diagnosed using by Rome III criteria. The results provide the pivotal information regarding the low-grade inflammation associated with functional GI disorders.Financial support: None.

“…For example, EGG abnormalities in children and adolescents with FD are independent of chronic gastritis, but associated with antral mast cell and eosinophil density [121,122] . Likewise, in children with FD, increased antral mast cell density is associated with slower gastric emptying [121] . As alluded to previously, the stress response also has effects on electromechanical function.…”

Section: Mechanisms Of Electromechanical Dysfunctionmentioning

confidence: 99%

Visceral hypersensitivity and electromechanical dysfunction as therapeutic targets in pediatric functional dyspepsia

Rosen

Cocjin

Schurman

et al. 2014

WJGPT

Functional gastrointestinal disorders (FGID) are common clinical syndromes diagnosed in the absence of biochemical, structural, or metabolic abnormalities. They account for significant morbidity and health care expenditures and are identifiable across variable age, geography, and culture. Etiology of abdominal pain associated FGIDs, including functional dyspepsia (FD), remains incompletely understood, but growing evidence implicates the importance of visceral hypersensitivity and electromechanical dysfunction. This manuscript explores data supporting the role of visceral hypersensitivity and electromechanical dysfunction in FD, with focus on pediatric data when available, and provides a summary of potential therapeutic targets. Visceral sensitivity and intestinal electromechanical function both are demonstrated to be altered in some FD patients and are potential targets for treatment. Limited studies in pediatric FD are available, but available evidence supports adult data that targeting visceral hypersensitivity and electromechanical dysfunction is warranted, particularly in the context of the biopsychosocial model. Future studies in pediatrics are needed to determine optimal therapy and appropriate patient application.Rosen JM, Cocjin JT, Schurman JV, Colombo JM, Friesen CA. Visceral hypersensitivity and electromechanical dysfunction as therapeutic targets in pediatric functional dyspepsia. World