Functional Dyspepsia and Duodenal Eosinophilia: A New Disease Model

Abstract

Functional dyspepsia (FD) is a highly prevalent disorder that affects more than 10% of the population. In the past decade, the conceptual underpinning of FD has begun to change, and new data are unraveling the underlying pathophysiological mechanisms of this disorder with a focus on the duodenum. The Rome IV criteria were published in 2016, and notably suggests that gastroesophageal reflux disease and irritable bowel syndrome may all be part of the same disease spectrum as FD. Helicobacter pylori explains a minority of FD cases and in Rome IV is considered a separate entity. Duodenal inflammation is likely to be an important with evidence that eosinophils (and mast cells) are increased and impair the intestinal barrier. Gastrointestinal infection is now an established risk factor for FD. Other risk factors for FD may include atopy, herbivore pets and antibiotic exposure. Gastroduodenal microbiome disturbances are an area of increasing interest in FD. Small bowel homing T cells and increased cytokines in the circulation occur in FD (correlating with slow gastric emptying), and an association with autoimmune rheumatological disease supports background immune activation. A genetic predisposition is possible. The link of FD to psychological disorders may indicate in some cases anxiety or depression causes FD while in others FD may induce psychological distress. Therapeutic options are limited, providing modest and temporary relief. Advances in the understanding of FD will likely alter clinical practice, and treatment of duodenal inflammation or microbiome alterations may lead to "cure" of a subset in the future.

from # All Medicine by Alexandros G. Sfakianakis via alkiviadis.1961 on Inoreader http://ift.tt/2yVKajz