Patients with dyspepsia have impaired mucosal integrity both in the duodenum and jejunum: in vivo assessment of small bowel mucosal integrity using baseline impedance

Abstract

Background Recent studies reported that impaired proximal duodenal mucosa, assessed by duodenal biopsy, could play an important role in the development of dyspeptic symptoms. The aims of this study were (a) to develop a method to measure ''in vivo'' duodenal and jejunal baseline impedance (BI) and (b) to assess small bowel mucosal integrity in patients with functional dyspepsia (FD) and healthy controls (HC). Methods We recruited 16 patients with FD and 15 HC. All subjects underwent ambulatory duodeno-jejunal manometry combined with impedance (HRM/Z), BI were determined by measuring impedance immediately after the passage of nocturnal migrating motor complex (MMC) phase IIIs. Results The number of MMC phase IIIs in FD was significantly lower than that in HC (2.6 ± 1.4 vs 4.8 ± 1.7, p \ 0.001). The BI in patients was significantly lower than that in HC in D1(164.2 ± 59.8 X in FD and 243.1 ± 40.5 X in HC, p = 0.0061), D2 (191.2 ± 34.1 and 256.5 ± 91.4 X, p = 0.01), D3 (214.0 ± 76.9 and 278.1 ± 45.3 X, p = 0.009), D4 (270.8 ± 54.2 and 351.8 ± 50.2 X, p \ 0.001), and J1 (312.2 ± 55.4 and 379.3 ± 38.3 X, p = 0.001). Conclusions This is the first study reporting the duodenal and jejunal BI in vivo. The results have shown significantly lowered BI in the proximal small intestine in patients with FD compared to HC. Furthermore it suggests that measurements of small bowel BI could be used as a biomarker for diagnosis and follow up of patients with FD.

The Role of Intestinal Permeability in Gastrointestinal Disorders and Current Methods of Evaluation

“…Since then, it has become clear that baseline impedance, measured by multichannel intraluminal impedance (MII) testing is lower in GERD patients compared to healthy volunteers and improves with medical and surgical therapy ( 53 , 54 ). More recently, a lower duodenal and jejunal baseline impedance was also demonstrated in patients with functional dyspepsia, corroborating previous ex vivo studies ( 55 ). The technique has recently been incorporated on a balloon that can be inserted through the biopsy channel of a standard endoscope.…”

Functional dyspepsia

“…This hypothesised association between impaired epithelial integrity, and the secretion of proinflammatory mediators by eosinophils and mast cells, is supported by studies demonstrating that patients with FD display impaired duodenal epithelial barrier function, both in vitro, with reduced expression of cell-to-cell adhesion proteins, 60 and in vivo, with decreased baseline impedance values. 65 Expression of zonulin occludens-1, a tight junction protein, was significantly lower in patients with FD in one study, 66 and the degree of impaired epithelial integrity correlated with mast cell and eosinophil counts. 60 Degranulation of eosinophils, with a resultant release of cytokines and chemokines, may also be increased, 62,67 although mast cells did not differ in their degranulation profiles, compared with those from healthy controls, but rather in their granular content.…”

“…Duodenal eosinophilia is now an established biomarker linked to symptoms of PDS, particularly early satiety, 62,63 but this requires counting eosinophils in five higher power fields, adding time and cost to patient evaluation. Although epithelial barrier disruption has been observed, 65 serum zonulin levels have not been of diagnostic value, 130 but this may reflect technical issues with measurement. FD can arise after acute gastroenteritis, 32 and antibodies to a common bacterial antigen, cytolethal distending toxin, may be increased, but these do not appear to be a useful diagnostic approach.…”

Food-Induced Duodenal Obstruction Successfully Reopened by Endoscopic Treatment

“…Changes in the number of intestinal cells of Cajal and myenteric neurons due to impaired mucosal integrity and low baseline impedance in the duodenum which result in abnormal gastroduodenal motility, have been reported in patients with FD [ 15 , 16 ]. Alternatively, a high-fat diet and microbial alteration are thought to cause enteric diabetic neuropathy and intestinal dysmotility based on the reduction of nitrergic myenteric neurons per ganglion in the duodenum [ 17 ].…”