Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2026
Prevalence and clinical implications of duodenal eosinophilia in patients with refractory functional dyspepsia: A cross-sectional analysis.
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Goyal Omesh, Khubber Manisha, Goyal Manjeet Kumar, Kaur Harpreet, Mehta Varun, Mahajan Ramit, Gupta Yogesh, Singh Arshdeep, Sood Ajit
Аннотация
BACKGROUND AND OBJECTIVES: Functional dyspepsia (FD) is a common disorder with multi-factorial pathophysiology. It has two sub-types, post-prandial distress syndrome (PDS) and epigastric pain syndrome (EPS), which frequently overlap. Emerging evidence suggests that low-grade inflammation, particularly duodenal eosinophilia (DE), may play a pathogenic role in FD. However, Indian data on this subject remains scarce. This study aimed at evaluating the prevalence and clinical correlates of DE in patients with refractory FD.
METHODS: In this prospective, cross-sectional study, Rome- IV defined FD patients with refractory symptoms and normal esophagogastroduodenoscopy (EGD) were enrolled. Age and sex-matched non-dyspeptic controls with normal EGD were also recruited. Standardized duodenal biopsies from cases and controls were independently assessed by two blinded histopathologists for eosinophil counts and degranulation. Symptom profiles and health-related quality of life (HRQoL) were evaluated using validated questionnaires.
RESULTS: Of 274 patients with refractory dyspepsia screened, 189 patients with normal EGD (mean age 41.4 ± 15.2 years; 54.5% males) were enrolled, along with 96 controls. The mean duodenal eosinophil count in controls was 8.2 ± 1.5 per high-power field (HPF). Applying the mean + 3 standard deviation criteria, DE was defined as ≥ 13 eosinophils/HPF. DE was identified in 65.3% (123/189) of refractory FD patients (65.7% in EPS, 52.5% in PDS and 69.1% in the overlap group, p > 0.05). Duodenal eosinophil counts correlated positively with PDS symptom severity (r = 0.376; p < 0.0001), overlap symptom severity (r = 0.3; p = 0.031) and worse HRQoL (r = 0.21; p = 0.010). Furthermore, patients with eosinophilic degranulation (24.3%) had significantly higher PDS scores and worse HRQoL scores, compared to those without degranulation.
CONCLUSIONS: Up to two-thirds of the refractory FD patients exhibited duodenal eosinophilia, which was associated with increased symptom severity in PDS and overlap sub-types and poorer HRQoL. These findings support the incorporation of duodenal mucosal assessment in the diagnostic algorithm for refractory FD.
METHODS: In this prospective, cross-sectional study, Rome- IV defined FD patients with refractory symptoms and normal esophagogastroduodenoscopy (EGD) were enrolled. Age and sex-matched non-dyspeptic controls with normal EGD were also recruited. Standardized duodenal biopsies from cases and controls were independently assessed by two blinded histopathologists for eosinophil counts and degranulation. Symptom profiles and health-related quality of life (HRQoL) were evaluated using validated questionnaires.
RESULTS: Of 274 patients with refractory dyspepsia screened, 189 patients with normal EGD (mean age 41.4 ± 15.2 years; 54.5% males) were enrolled, along with 96 controls. The mean duodenal eosinophil count in controls was 8.2 ± 1.5 per high-power field (HPF). Applying the mean + 3 standard deviation criteria, DE was defined as ≥ 13 eosinophils/HPF. DE was identified in 65.3% (123/189) of refractory FD patients (65.7% in EPS, 52.5% in PDS and 69.1% in the overlap group, p > 0.05). Duodenal eosinophil counts correlated positively with PDS symptom severity (r = 0.376; p < 0.0001), overlap symptom severity (r = 0.3; p = 0.031) and worse HRQoL (r = 0.21; p = 0.010). Furthermore, patients with eosinophilic degranulation (24.3%) had significantly higher PDS scores and worse HRQoL scores, compared to those without degranulation.
CONCLUSIONS: Up to two-thirds of the refractory FD patients exhibited duodenal eosinophilia, which was associated with increased symptom severity in PDS and overlap sub-types and poorer HRQoL. These findings support the incorporation of duodenal mucosal assessment in the diagnostic algorithm for refractory FD.