Implications of Eosinophilia in the Normal Duodenal Biopsy – an Association with Allergy and Functional Dyspepsia

Marjorie M Walker (1) , Sormeh S Salehian (2) , Nick Powell (3) , Arun Rajendran (4) , Claire E Murray (5) , Jonathan M Hoare (3) , Rupert Negus (3) , Nicholas J Talley (6)

1 Histopathology
2 Histopathology
3 Gastroenterology
4 Gastroenterology
5 Cellular Pathology
6 Department of Internal Medicine

Background: Allergy and functional gastrointestinal disorders have been associated with eosinophilia in duodenal mucosa. Aim: To assess the prevalence of eosinophilia in duodenal biopsies of patients attending for oesophogastroduodenoscopy and delineate associated clinical conditions. Methods: 155 patients (mean age 55 years, 59% females) with normal duodenal biopsies were randomly selected for audit from histopathology files. Eosinophil counts in 5 high power fields (HPFs) were assessed. Records were analysed for symptoms, diagnosis and medications; patients divided into 5 groups based on upper gastrointestinal (UGI) symptom profiles, including a control group of those without predominant UGI symptoms. The prevalence of duodenal eosinophilia (defined as >22/5HPFs a priori) was calculated. Results: In the control group the mean duodenal eosinophil count was 15/5HPFs; prevalence of duodenal eosinophilia 22.5%. In postprandial distress syndrome (PDS) both mean eosinophil counts (20.2/5HPF, p<0.04) and prevalence of duodenal eosinophilia (47.3%, p<0.04) were significantly higher. Duodenal eosinophilia was significantly associated with allergy (OR 5.04, 95% CI 2.12-11.95, p<0.001). There was no association with irritable bowel syndrome or medications. Conclusions: Subtle duodenal eosinophilia is relatively common in routine oesophogastroduodenoscopy and previously overlooked; it is associated with allergy and may indicate a hypersensitivity mechanism in some patients with PDS including early satiety.

Mots clés: Medicine

Marjorie M Walker, Sormeh S Salehian, Nick Powell, Arun Rajendran, Claire E Murray, et al.. Implications of Eosinophilia in the Normal Duodenal Biopsy – an Association with Allergy and Functional Dyspepsia. Alimentary Pharmacology and Therapeutics, 2010, 31 (11), pp.1229. ⟨10.1111/j.1365-2036.2010.04282.x⟩. ⟨hal-00552540⟩