DUODENAL eosinophil count was significantly higher in patients with functional dyspepsia than in matched controls, according to new findings that strengthen evidence for a role of low-grade immune activation in the disorder’s pathogenesis.
Duodenal Eosinophil Count and Functional Dyspepsia
Functional dyspepsia has a multifactorial pathogenesis and increasing attention has focused on the potential contribution of duodenal eosinophilia to immune activation in this common gastrointestinal disorder. Researchers conducted a case-control study to evaluate the association between increased duodenal eosinophil count and functional dyspepsia.
The study was carried out in the Department of Gastroenterology at Sir Salimullah Medical College, Mitford Hospital, Dhaka, Bangladesh, from January–December 2022. A total of 46 adults with functional dyspepsia diagnosed according to Rome III criteria were enrolled as cases. The control group consisted of 40 age- and sex-matched individuals without functional dyspepsia who underwent upper gastrointestinal endoscopy for other indications and had normal endoscopic findings.
Multiple biopsies were obtained from the second part of the duodenum. Tissue sections were formalin fixed, paraffin embedded and stained with haematoxylin and eosin. Investigators manually counted eosinophils under light microscopy in five randomly selected high-power fields at x400 magnification and calculated the mean eosinophil count per high-power field.
Significant Increase in Eosinophilic Infiltration
Analysis showed that the mean duodenal eosinophil count was markedly higher among patients with functional dyspepsia than among controls: 23.98±7.98 eosinophils/high power field; 15.63±5.94 eosinophils/high power field; p<0.001.
Duodenal eosinophilia, defined as ≥21 eosinophils per high power field, was identified in 69.6% of patients with functional dyspepsia compared with 17.5% of controls. The data also demonstrated a strong association between increased duodenal eosinophil count and functional dyspepsia: (odds ratio: 9.74; 95% CI: 3.50–27.08).
Implications for Disease Pathogenesis
The findings suggest that patients with functional dyspepsia exhibit substantially greater duodenal eosinophilic infiltration than individuals without the condition. This observation supports the hypothesis that low-grade immune activation may contribute to disease development and symptom generation.
Conclusion
While the results provide further evidence linking duodenal eosinophil count to functional dyspepsia, the investigators noted that additional multicentre studies with larger sample sizes are needed. Further research may help clarify the clinical significance of duodenal eosinophilia and its potential role in the evaluation and management of functional dyspepsia.
Reference
Mahbub I et al. Association between increased duodenal eosinophil count and functional dyspepsia. PLoS One. 2026;21(6):e0351741.
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