Eosinophils and mast cells as therapeutic targets in pediatric functional dyspepsia

Abstract

There is an increasing appreciation for the importance of inflammation as a pathophysiologic entity that contributes to functional gastrointestinal disorders including functional dyspepsia (FD). Importantly, inflammation may serve as a mediator between psychologic and physiologic functions. This manuscript reviews the literature implicating two inflammatory cell types, mast cells and eosinophils, in the generation of dyspeptic symptoms and explores their potential as targets for the treatment of FD. There are a number of inciting events which may initiate an inflammatory response, and the subsequent recruitment and activation of mast cells and eosinophils. These include internal triggers such as stress and anxiety, as well as external triggers such as microbes and allergens. Previous studies suggest that there may be efficacy in utilizing medications directed at mast cells and eosinophils. Evidence exists to suggest that combining "anti-inflammatory" medications with other treatments targeting stress can improve the rate of symptom resolution in pediatric FD.

Therapeutic effect of melatonin on pediatric functional dyspepsia: A pilot study

“…It is a common diagnosis in children with population prevalence estimates of 3.5% to 27% [1,2] . A number of biologic contributors to the generation of FD have been identified and include inflammation, electromechanical dysfunction (e.g., altered gastric emptying) and visceral hyperalgesia [3,4] . Melatonin, a hormone produced, in part, by the pineal gland, has a well-known role in regulation of sleep-wake cycles through its sleep promoting effects.…”

Editorial: the diminishing returns of normalisation of the oesophageal mucosa

“…Anti-inflammatory agents and drugs aimed at decreasing allergic reactions are already being studied in functional dyspepsia. 9,10 Observational studies, while confirming the original observation of duodenal eosinophilia, need to give way to mechanistic studies that help us understand the pathogenesis of duodenal eosinophilia. Future studies will help determine if treating the eosinophilia, much as we treat eosinophilic oesophagitis, or restricting the diet will alleviate dyspeptic symptoms.…”

Functional Dyspepsia

“…If this hypothesis is correct, then some patients with functional dyspepsia may have a response to therapy targeted at immune activation, but this remains to be established; however, preliminary data in children suggest that montelukast, a leukotriene-receptor antagonist, reduces symptoms. 49 Tr e atment of Func tiona l Dyspepsi a…”