Mucosal eosinophils, mast cells, and intraepithelial lymphocytes in youth with rumination syndrome

Abstract

Background Rumination syndrome has been associated with increased duodenal eosinophils and intraepithelial lymphocytes in adults. The aims of the current study were to assess densities of antroduodenal eosinophils and mast cells and duodenal intraepithelial lymphocytes in youth with rumination syndrome and to compare cell densities in those with and without abdominal pain or early satiety. Methods Twenty‐eight youth fulfilling Rome IV criteria for rumination syndrome who had undergone endoscopy were identified and compared to 10 controls. Antral and duodenal biopsies were assessed to determine densities of eosinophils, mast cells, and intraepithelial lymphocytes. Cell densities were also compared between rumination patients with and without abdominal pain and those with and without early satiety. Key results Antral mast cell (peak 18.5±6.5 vs. 12.5±2.7) and eosinophil (peak 9.6±5.2 vs. 4.9±2.1) densities were significantly greater in patients with rumination syndrome as compared to controls. Duodenal intraepithelial lymphocyte densities were also increased in rumination syndrome (18.9 ± 5.1 vs. 11.7 ± 1.5; p<.001). Associations were independent of the presence of abdominal pain or early satiety. Conclusions and Inferences In conclusion, we found an increase in eosinophil and mast cell densities in the gastric antrum and an increase in intraepithelial lymphocytes in the duodenum in youth with rumination syndrome which was independent of the presence of abdominal pain or early satiety. These findings suggest a potential role for inflammation in the pathophysiology of rumination syndrome. Future studies should address whether treatment directed at these cells are beneficial in treating rumination syndrome.

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).…”

Presence of Increased Mast Cells in Infants and Children with Volume and Variety Limited Intake

“…In patients with eosinophilic esophagitis, higher tryptase levels are associated with increased frequency of nausea [11]. A recent study in pediatric patients with rumination syndrome demonstrated increased eosinophil and mast cell densities in the gastric antrum [12]. Reports indicate a high proportion of patients with feeding difficulties who have undergone esophagogastroduodenoscopy (EGD), demonstrate some degree of inflammation on biopsies [4,13], with a subset including those with eosinophilia [14].…”

Letter: eosinophilic duodenitis and increased intraepithelial lymphocytes in rumination syndrome – more evidence

“…We calculated pooled mean difference (MD) and 95% confidence intervals (CI) for the cell counts in those with rumination syndrome and the control group using a random-effects model. 3 We identified 1003 studies; after the removal of studies that did not meet the inclusion criteria, two studies (50 cases, 20 controls) were analysed 4,5 ; results are in Table 1. On pooled analysis, those with rumination syndrome had on average more eosinophils per five highpower fields than controls.…”