Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Department of Gastroenterology, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang, China.
J Gastroenterol Hepatol. 2018 Jan;33(1):128-133. doi: 10.1111/jgh.13813.
Dietary factors and immune dysfunction may induce symptoms in patients with functional dyspepsia (FD). The aim of the study was to evaluate whether gluten consumption impacts symptom onset in patients with FD and to evaluate for possible histologic alterations in the duodenum of patients with FD.
We prospectively enrolled 101 patients newly diagnosed with FD and 31 asymptomatic controls. Specific FD symptoms and gluten consumption patterns were evaluated by self-reported questionnaires. Tight junction protein (claudin-1) expression and presence of intraepithelial lymphocyte (IEL) infiltration in the bulb (D1) and second portion (D2) of the duodenum were assessed by immunohistochemistry.
Wheat bun consumption had higher frequency (P = 0.047) and increased average consumption (P = 0.01) scores in patients with FD compared with the control group. Of the 101 patients with FD, early satiety (P = 0.03) was associated with increased wheat bun consumption frequency score. On histologic evaluation, claudin-1 expression was decreased in D1 (0.003 ± 0.001 vs 0.012 ± 0.002, P = 0.003) and D2 (0.002 ± 0.0004 vs 0.012 ± 0.001, P < 0.001), while duodenal IEL counts were increased in D1 (15.5 ± 7.8 vs 3.1 ± 2.5, P < 0.001) and D2 (20.6 ± 7.7 vs 5.8 ± 3.4, P < 0.001) among patients with FD compared with the control group. Finally, Helicobacter pylori infection was associated with increased IELs in D1 (20.6 ± 7.0 vs 14.2 ± 7.4, P = 0.001) among patients with FD.
Among patients with FD, gluten-rich food may lead to symptom onset, specifically early satiety. Intestinal epithelial barrier dysfunction characterized by decreased claudin-1 expression and mucosal immune activation demonstrated by IEL infiltration may contribute to the pathogenesis of FD.
饮食因素和免疫功能障碍可能会导致功能性消化不良（FD）患者出现症状。本研究旨在评估麸质摄入是否会影响 FD 患者的症状发作，并评估 FD 患者十二指肠是否存在可能的组织学改变。
我们前瞻性地招募了 101 例新诊断为 FD 的患者和 31 例无症状对照者。通过自我报告问卷评估特定的 FD 症状和麸质摄入模式。通过免疫组织化学评估紧密连接蛋白（claudin-1）表达和十二指肠球部（D1）和第二部分（D2）上皮内淋巴细胞（IEL）浸润的存在。
FD 患者中，与对照组相比，小麦面包的食用频率更高（P=0.047），平均食用量也更高（P=0.01）。在 101 例 FD 患者中，早饱（P=0.03）与小麦面包食用频率评分增加有关。在组织学评估中，D1（0.003±0.001 对 0.012±0.002，P=0.003）和 D2（0.002±0.0004 对 0.012±0.001，P<0.001）的 claudin-1 表达降低，而 D1（15.5±7.8 对 3.1±2.5，P<0.001）和 D2（20.6±7.7 对 5.8±3.4，P<0.001）的十二指肠 IEL 计数增加。最后，与 FD 患者相比，幽门螺杆菌感染与 D1 中 IEL 增加有关（20.6±7.0 对 14.2±7.4，P=0.001）。
在 FD 患者中，富含麸质的食物可能会导致症状发作，特别是早饱。由 claudin-1 表达减少和 IEL 浸润引起的黏膜免疫激活导致的肠上皮屏障功能障碍可能有助于 FD 的发病机制。
