Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.
Department of Gastroenterology, John Hunter Children's Hospital, Newcastle, NSW, Australia.
Aliment Pharmacol Ther. 2017 May;45(10):1358-1364. doi: 10.1111/apt.14045. Epub 2017 Mar 21.
The pathophysiology of functional dyspepsia (FD) remains unknown. Duodenal eosinophil infiltration has been reported.
To assess the association between dyspeptic symptoms and duodenal eosinophilia in children undergoing upper gastrointestinal endoscopy.
In this retrospective cohort study, children with normal upper endoscopy and routine histology at a single tertiary paediatric centre between 2010 and 2014 were included. FD was defined as epigastric pain or discomfort >2 months without response to acid suppression. Controls presented with nonerosive reflux disease, dysphagia or rumination syndrome. Intramucosal eosinophil counts were compared between the groups using uni- and multivariate regression analyses.
Thirty-six cases and 36 nonmatched controls were identified. Atopic history (39% vs. 25%) and psychological comorbidity (53% vs. 39%; both P = 0.2) were frequent in cases and controls. Self-reported nausea (64% vs. 17%; P < 0.0001), lethargy (19% vs. 0%; P = 0.005) and family functional gastrointestinal disorder(FGID) (28% vs. 3%; P = 0.003) were more common in cases than controls. Duodenal eosinophil counts [median (IQR): 151 (118-207) vs. 76 (60-106) per mm ; P < 0.001] were significantly higher in cases than controls with >112 eosinophils per mm predictive for FD (OR: 33.6, 95% CI: 7.1-159.0; P < 0.001). Duodenal eosinophilia was associated with weight loss (OR: 7.1, 95% CI: 1.1-45.5; P = 0.04).
Functional dyspepsia in children is strongly associated with duodenal eosinophilia, in the absence of endoscopic or routine histological findings. Frequent atopic and psychological comorbidity illustrate likely multifactorial mechanisms.
功能性消化不良（FD）的病理生理学仍然未知。据报道，十二指肠嗜酸性粒细胞浸润与 FD 有关。
评估儿童上消化道内镜检查中消化不良症状与十二指肠嗜酸性粒细胞浸润之间的关系。
在这项回顾性队列研究中，纳入了 2010 年至 2014 年在一家三级儿科中心接受正常上消化道内镜和常规组织学检查的儿童。FD 的定义为上腹痛或不适>2 个月，且质子泵抑制剂治疗无效。对照组表现为非糜烂性反流病、吞咽困难或反刍综合征。使用单变量和多变量回归分析比较两组间的黏膜内嗜酸性粒细胞计数。
共纳入 36 例病例和 36 例非匹配对照。病例组和对照组均有较高的特应性病史（39%比 25%，P=0.2）和心理合并症（53%比 39%，均 P=0.2）。病例组自我报告的恶心（64%比 17%，P<0.0001）、乏力（19%比 0%，P=0.005）和家族功能性胃肠道疾病（FGID）（28%比 3%，P=0.003）更为常见。病例组十二指肠嗜酸性粒细胞计数[中位数（IQR）：151（118-207）比 76（60-106）个/mm；P<0.001]显著高于对照组，>112 个/mm 的嗜酸性粒细胞提示 FD（比值比：33.6，95%CI：7.1-159.0；P<0.001）。十二指肠嗜酸性粒细胞浸润与体重减轻相关（比值比：7.1，95%CI：1.1-45.5；P=0.04）。
在没有内镜或常规组织学发现的情况下，儿童功能性消化不良与十二指肠嗜酸性粒细胞浸润密切相关。常见的特应性和心理合并症表明可能存在多种机制。
