Functional Dyspepsia, 2016

Nicholas J. Talley; Marjorie M. Walker; Gerald Holtmann


Curr Opin Gastroenterol. 2016;32(6):467-473. 

In This Article

Duodenal Inflammation

Following the landmark report that duodenal eosinophils are increased in adult cases with functional dyspepsia based on quantitative histology (a total of 22 or more eosinophils in five high-power fields in the duodenal bulb was associated with an 11-fold increase in functional dyspepsia), the association of duodenal eosinophilia with functional dyspepsia[22] has since been confirmed worldwide.[2] Others have observed that duodenal mast cells are increased in some functional dyspepsia cases,[23] as well as increased duodenal permeability in functional dyspepsia;[24] increased mast cells with eosinophils may be linked to functional dyspepsia and IBS overlap.[1] An elegant study from Belgium examining submucosal nerves and ganglia has extended these seminal observations.[25] In functional dyspepsia cases compared with controls, both abnormalities of structure (gliosis, abnormal ganglion architecture) and function (decreased nerve calcium responses) were observed in functional dyspepsia, and further, increased eosinophils and mast cells correlated significantly with submucous ganglia functional changes. The evidence supports the hypothesis that subtle duodenal inflammation with eosinophils and, in some cases, mast cells is a driver of altered neural function in functional dyspepsia, and, as the duodenum is a central controller of gastric and intestinal function, may help explain other gastroduodenal motor and sensor abnormalities reported in functional dyspepsia. An excellent summary reviewing the possible role of mast cells in functional dyspepsia and other diseases has been published.[23]