Pantai Hospital, Department of Medicine, Kuala Lumpur, Malaysia.
Pantai Integrated Labs, Pantai Hospital Kuala Lumpur, Malaysia.
Med J Malaysia. 2024 Sep;79(5):556-560.
Duodenal eosinophilia has been implicated in the pathophysiology of functional dyspepsia. In a retrospective observational study, we previously reported that duodenal eosinophilia (as defined by a mucosal count of greater than 15 eosinophils per 5 high power fields), was associated with symptomatic erosive gastroesophageal reflux disease (GERD), concomitant co-morbidities and Chinese ethnicity but not functional dyspepsia among 289 multiracial subjects undergoing diagnostic endoscopy in 2019 before the COVID-19 pandemic. We tested the reproducibility of those findings on a larger sample that included the original cohort and another 221 subjects who underwent endoscopy in 2022 after the easing of pandemic restrictions.
Archived duodenal histology slides were assessed by a pathologist blind to demographic and clinical data gleamed retrospectively from clinical chart review. Logistic regression analysis was used to explore associations between duodenal eosinophilia and the variables age, gender, ethnicity, year of sampling (2019 vs 2022), concomitant co-morbidities, functional dyspepsia, symptomatic erosive GERD (Los Angeles Grades A to D), endoscopic oesophagitis, gallstone disease, Helicobacter pylori infection, irritable bowel syndrome and NSAID consumption. Three different thresholds for defining duodenal eosinophilia (>15, >22 and >30 eosinophils per 5 high power fields) were tested.
Year of sampling (2019, pre-pandemic) strongly predicted duodenal eosinophilia across all thresholds (OR 11.76, 13.11 and 21.41 respectively; p = 0.000). The presence of concomitant co-morbidities was a modest predictor across all thresholds whereas Chinese ethnicity only predicted at the lowest threshold. Absolute duodenal eosinophil counts predicted symptomatic erosive GERD (OR 1.03; p = 0.015) but not functional dyspepsia (OR 1.00; p = 0.896) after adjusting for age, gender, ethnicity, concomitant comorbidities and year of endoscopy. None of the subjects reached the threshold for the diagnosis of eosinophilic duodenitis.
The cumulative impact of environmental exposures on duodenal eosinophil counts may be much greater than of putative factors linked to functional dyspepsia. A signal linking duodenal eosinophil counts and symptomatic erosive GERD was detected.
十二指肠嗜酸性粒细胞增多症与功能性消化不良的病理生理学有关。在一项回顾性观察研究中，我们之前报告说，十二指肠嗜酸性粒细胞增多症（定义为黏膜每 5 高倍视野中嗜酸性粒细胞计数大于 15 个）与有症状的糜烂性胃食管反流病（GERD）、并存的合并症和中国种族有关，但与 2019 年 COVID-19 大流行前接受诊断性内镜检查的 289 名多种族受试者中的功能性消化不良无关。我们在一个更大的样本中测试了这些发现的重现性，该样本包括原始队列和另外 221 名在大流行限制放宽后于 2022 年接受内镜检查的受试者。
通过病理学家评估存档的十二指肠组织学切片，病理学家对从临床图表回顾中回顾性收集的人口统计学和临床数据一无所知。使用逻辑回归分析探索了十二指肠嗜酸性粒细胞增多症与年龄、性别、种族、采样年份（2019 年与 2022 年）、并存合并症、功能性消化不良、有症状的糜烂性 GERD（洛杉矶 A 至 D 级）、内镜食管炎、胆囊疾病、幽门螺杆菌感染、肠易激综合征和 NSAID 消费之间的关联。测试了定义十二指肠嗜酸性粒细胞增多症的三个不同阈值（>15、>22 和 >30 个嗜酸性粒细胞/5 个高倍视野）。
采样年份（2019 年，大流行前）强烈预测了所有阈值的十二指肠嗜酸性粒细胞增多症（OR 分别为 11.76、13.11 和 21.41；p = 0.000）。并存合并症是所有阈值的适度预测因素，而中国种族仅在最低阈值预测。绝对十二指肠嗜酸性粒细胞计数预测有症状的糜烂性 GERD（OR 1.03；p = 0.015），但不预测功能性消化不良（OR 1.00；p = 0.896），调整年龄、性别、种族、并存合并症和内镜检查年份后。没有受试者达到嗜酸性粒细胞性十二指肠炎的诊断阈值。
环境暴露对十二指肠嗜酸性粒细胞计数的累积影响可能远大于与功能性消化不良相关的潜在因素。检测到十二指肠嗜酸性粒细胞计数与有症状的糜烂性 GERD 之间的信号联系。
