Clinical Implications of Low-grade Duodenal Eosinophilia in Functional Dyspepsia: A Prospective Real-life Study

BACKGROUND

Functional dyspepsia (FD) is a multifactorial disorder with no targeted therapy. Duodenal eosinophilia and low-grade inflammation are potential pathogenic mechanisms. However, the impact of duodenal eosinophils (D-EO) histologic evaluation in real-life clinical practice was not explored.

AIM

To evaluate the clinical utility of D-EO and low-grade inflammation in FD in real-life practice.

MATERIALS AND METHODS

A multicenter prospective study was conducted. A total of 636 patients who meet Rome-III criteria were selected before upper endoscopy and 516 patients were included after normal endoscopy were assessed. Clinical parameters, Helicobacter pylori ( H. pylori), and duodenal histology were evaluated.

RESULTS

FD subtypes were 231 (45%) patients who had epigastric pain syndrome (EPS), 168 (33%) postprandial distress syndrome (PDS), and 117 (22%) EPS/PDS overlap. Two hundred fifty-nine (50.3%) patients were H. pylori+ . Histologic duodenal grading of chronic inflammation and intraepithelial lymphocytes showed no difference between FD subtypes. Increased in D-EO densities (>10 per high power field) was significant in PDS compared with EPS and EPS/PDS overlap subtypes. The odds ratio of PDS in subjects with duodenal eosinophilia densities was 2.28 (95% CI, 1.66-3.14; P <0.0001), adjusting for age, gender, H. pylori and nonsteroidal anti-inflammatory drug the odds ratio was 3.6 (95% CI, 2.45-5.28; P <0.0001). receiver operating characteristic curve analysis further demonstrated that low-grade duodenal eosinophilia, in particular H. pylori- , was highly accurate for PDS with the area under the curve 0.731 compared with H. pylori+ area under the curve 0.598. Furthermore, low-grade duodenal eosinophilia was significantly correlated with treatment response under 4 to 6 weeks of proton pump inhibitor therapy.

CONCLUSION

Our findings suggest that low-grade duodenal eosinophilia is associated with PDS subtype non- H. pylori FD patients and could be a useful marker of treatment response.

Low-grade duodenal eosinophilia is associated with cagA in Helicobacter pylori-related dyspepsia

BACKGROUND AND AIM

Functional dyspepsia (FD) is a multifactorial disorder. Helicobacter pylori (H. pylori)-related dyspepsia (HpD) may be considered a separate entity. Duodenal eosinophilia is a potential pathogenic mechanism in FD. However, the impact of duodenal eosinophilia and H. pylori virulence genes in HpD was not explored. We aim to evaluate the association of H. pylori virulence genes and low-grade duodenal eosinophilia in HpD.

METHODS

A multi-center cross-sectional study was conducted. A total of 301 patients who meet Rome-III criteria were selected before upper endoscopy, and 95 patients were included after normal endoscopy and positive H. pylori in gastric biopsies were assessed. Clinical parameters, H. pylori virulence genes (cagA, oipA, and vacA) and duodenal histology were evaluated.

RESULTS

Sixty-nine (72%) patients had epigastric pain syndrome (EPS), 17 (18%) post-prandial distress syndrome (PDS) and 9 (10%) EPS/PDS overlap. FD syndromes were not associated with cagA or oipA strains. A significantly trend of vacA s1/m1 (78%) and s1/m2 (80%) positive strains in EPS was observed. Histological duodenal grading of chronic inflammation, low-grade duodenal eosinophilia and intra-epithelial lymphocytes showed no difference in oipA and vacA strains. Low-grade duodenal eosinophilia was significant in cagA positive strain, and the OR for low-grade duodenal eosinophilia with H. pylori cagA positive strain was 4.2 (95% CI, 1.78-9.93). Adjusting for age, gender, smoking, diabetes, alcohol, PPI, and NSAID, the OR was 5.44 (1.989-14.902).

CONCLUSION

Our findings suggest that low-grade duodenal eosinophilia is significantly associated with cagA strain in HpD.

Neustonic microplastics and zooplankton in coastal waters of Cabrera Marine Protected Area (Western Mediterranean Sea)

The high abundance of microplastics in marine environments is becoming a growing threat for Marine Protected Areas (MPAs). Recent studies have identified microplastics (MP) as having multiple effects on biota, and it is of special interest to highlight their effects on zooplanktonic organisms. These organisms play a key role on local food web structures and there is a need to better understand the accumulation of MPs and associated contaminants within the food web. The present study addresses MP distribution and composition within Cabrera MPA as well as its effects on local zooplanktonic community composition. Neustonic microplastic and zooplankton abundance and composition were determined in the shallow coastal waters of Cabrera MPA during the summer season of 2019. Samples were taken using a sea surface manta-net, with a mesh size of 335 μm. MPs were found in all manta trawl samples for a total of 7047 MP with an overall mean abundance (± SD) of 3.52 (± 8.81) items/m³, a value higher than those reported for the majority of Western Mediterranean Sea basins. Qualitative and semi-quantitative analyses of the local zooplankton community suggest that its composition could be sensitive to MP abundances. Although no correlation was found between overall mean abundance of MP and zooplankton, a positive correlation was found between MP abundance and the abundance of the planktonic stage of the foraminifer Rosalina globularis (Tretomphalus). This species seems to be able to use MP for its dispersion. On the other hand, a negative correlation between MP abundance and Copepoda abundance was detected. This work confirms that the coastal zooplankton community composition within the MPA of Cabrera are not exempt from MP pollution and suggests important and complex interactions between MP and zooplankton organisms in coastal waters.

Impact of the marine litter pollution on the Mediterranean biodiversity: A risk assessment study with focus on the marine protected areas

In this paper a novel methodology to assess the risk of marine litter (ML) pollution in the Mediterranean Sea is implemented. In this approach, the hazard component is estimated using a state-of-the-art 3D modeling system, which allows the simulation of floating and sinking ML particles; the exposure component is defined from biodiversity estimates; and the vulnerability is related to ML ingestion rates of each species. The results show that the hot-spots for the ML risk concentrate in the coastal regions, and are mainly conditioned by the biodiversity in the region. A dedicated analysis on the marine protected areas shows that the risk therein is controlled by the proximity to ML sources and that their present-day protection levels are not effective in the case of ML pollution. Only a reduction of ML at the sources could reduce the impact of ML pollution in protected areas.