目的:饮食因素和免疫功能紊乱可引起功能性消化不良(FD)患者的症状。该研究的目的是评估麸质消耗是否会影响FD患者的症状发作,并评估FD患者十二指肠的可能组织学改变。
方法:我们前瞻性纳入101例新诊断为FD的患者和31例无症状对照。通过自我报告问卷评估特定的FD症状和麸质消耗模式。通过免疫组织化学评估十二指肠球部(D1)和第二部分(D2)中紧密连接蛋白(claudin-1)的表达和上皮内淋巴细胞(IEL)浸润的存在。
结果:与对照组相比,FD患者的小麦面包消耗频率更高(P=0.047),平均消耗得分更高(P=0.01)。101例FD患者中,早期饱腹感(P=0.03)与小麦面包消费频率得分增加有关。关于组织学评估,claudin-1表达在D1(0.003±0.001vs0.012±0.002,P=0.003)和D2(0.002±0.0004vs0.012±0.001,P<0.001)中降低,与对照组相比,FD患者的十二指肠IEL计数在D1(15.5±7.8vs3.1±2.5,P<0.001)和D2(20.6±7.7vs5.8±3.4,P<0.001)中增加。最后,在FD患者中,幽门螺杆菌感染与D1中IEL的增加有关(20.6±7.0vs14.2±7.4,P=0.001)。
结论:在FD患者中,富含麸质的食物可能导致症状发作,特别是早期饱腹感。IEL浸润显示的以claudin-1表达降低和粘膜免疫激活为特征的肠上皮屏障功能障碍可能与FD的发病机理有关。
OBJECTIVE: Dietary factors and immune dysfunction may induce symptoms in patients with functional dyspepsia (FD). The aim of the study was to evaluate whether gluten consumption impacts symptom onset in patients with FD and to evaluate for possible histologic alterations in the duodenum of patients with FD.
METHODS: We prospectively enrolled 101 patients newly diagnosed with FD and 31 asymptomatic controls. Specific FD symptoms and gluten consumption patterns were evaluated by self-reported questionnaires. Tight junction protein (claudin-1) expression and presence of intraepithelial lymphocyte (IEL) infiltration in the bulb (D1) and second portion (D2) of the duodenum were assessed by immunohistochemistry.
RESULTS: Wheat bun consumption had higher frequency (P = 0.047) and increased average consumption (P = 0.01) scores in patients with FD compared with the control group. Of the 101 patients with FD, early satiety (P = 0.03) was associated with increased wheat bun consumption frequency score. On histologic evaluation, claudin-1 expression was decreased in D1 (0.003 ± 0.001 vs 0.012 ± 0.002, P = 0.003) and D2 (0.002 ± 0.0004 vs 0.012 ± 0.001, P < 0.001), while duodenal IEL counts were increased in D1 (15.5 ± 7.8 vs 3.1 ± 2.5, P < 0.001) and D2 (20.6 ± 7.7 vs 5.8 ± 3.4, P < 0.001) among patients with FD compared with the control group. Finally, Helicobacter pylori infection was associated with increased IELs in D1 (20.6 ± 7.0 vs 14.2 ± 7.4, P = 0.001) among patients with FD.
CONCLUSIONS: Among patients with FD, gluten-rich food may lead to symptom onset, specifically early satiety. Intestinal epithelial barrier dysfunction characterized by decreased claudin-1 expression and mucosal immune activation demonstrated by IEL infiltration may contribute to the pathogenesis of FD.