Functional Dyspepsia and Food: Immune Overlap with Food Sensitivity Disorders
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STOMACH AND DUODENUM (J PISEGNA AND J BENHAMMOU, SECTION EDITORS)
Functional Dyspepsia and Food: Immune Overlap with Food Sensitivity Disorders Jennifer Pryor 1,2,3 & Grace L. Burns 1,2,3 & Kerith Duncanson 2,3,4 & Jay C. Horvat 1,3 & Marjorie M. Walker 2,3,4 & Nicholas J. Talley 2,3,4 & Simon Keely 1,2,3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Functional dyspepsia (FD) is a chronic functional gastrointestinal disorder characterised by upper gastrointestinal symptoms. Here, we aimed to examine the evidence for immune responses to food in FD and overlap with food hypersensitivity conditions. Recent Findings A feature of FD in a subset of patients is an increase in mucosal eosinophils, mast cells, intraepithelial cytotoxic T cells and systemic gut-homing T cells in the duodenum, suggesting that immune dysfunction is characteristic of this disease. Rates of self-reported non-celiac wheat/gluten sensitivity (NCW/GS) are higher in FD patients. FD patients commonly report worsening symptoms following consumption of wheat, fermentable oligosaccharides, disaccharides, monosaccharides, or polyols (FODMAPs), high-fat foods and spicy foods containing capsaicin. Particularly, wheat proteins and fructan in wheat may drive symptoms. Summary Immune mechanisms that drive responses to food in FD are still poorly characterised but share key effector cells to common food hypersensitivities including non-IgE–mediated food allergy and eosinophilic oesophagitis. Keywords Functional dyspepsia . Food allergy . Diet . Non-celiac wheat sensitivity . Duodenum . FODMAPs
Introduction Functional dyspepsia (FD) is a common functional gastrointestinal disorder (FGID) with a prevalence of approximately 10% in Western countries [1]. This condition is characterised by chronic upper gastrointestinal (GI) symptoms including epigastric pain, epigastric burning, early satiety, postprandial fullness (often referred to as bloating) and nausea. FD is This article is part of the Topical Collection on Stomach and Duodenum * Simon Keely [email protected] 1
School of Biomedical Sciences & Pharmacy, Faculty of Health & Medicine, University of Newcastle, Newcastle, NSW, Australia
2
Priority Research Centre for Digestive Health and Neurogastroenterology, University of Newcastle, Newcastle, NSW, Australia
3
Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
4
School of Medicine and Public Health, Faculty of Health & Medicine, University of Newcastle, Newcastle, NSW, Australia
diagnosed in patients with persistent symptoms, as defined by the Rome criteria, who have negative endoscopic findings and overt pathology upon examination [2]. Patients are generally assigned to one of two subtypes based on symptoms: postprandial distress syndrome (PDS) or epigastric pain syndrome (EPS) although pathophysiology of FD is poorly defined, and it is unclear if there is a biological basis for these subtypes [2]. Quality of life is poor in FD patients, with significant social and hea
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