Associations of Meal‐Related and Somatic Symptoms With Mucosal Eosinophil and Mast Cell Counts in Youth With Disorders of Gut–Brain Interaction

INTRODUCTION: Meal-related symptoms are commonly identified in disorders of gut-brain interaction (DGBIs). Gastroduodenal low-grade inflammation involving mucosal eosinophils and/or mast cells has been previously described in patients with DGBIs. In children with DGBIs, we sought to determine potential relationships between gastric and duodenal mucosal eosinophils and mast cells with specific meal-related and non-GI somatic symptoms. METHODS: Two hundred eight youth with AP-DGBI were evaluated. All patients underwent esophagogastroduodenoscopy (EGD) with biopsies taken from the gastric antrum and duodenum. Patients completed symptom and BASC-3 questionnaires to evaluate somatization and the presence of specific meal-related and non-GI somatic symptoms. A single observer blinded to clinical data reported maximum density of eosinophils and mast cells. KEY RESULTS: Mucosal eosinophil and mast cell counts did not differ between FD and IBS nor between FD subtypes. After correction for multiple comparisons, there were no associations between eosinophil or mast cell counts with meal-related symptoms. In contrast, duodenal mast cells were positively associated with headaches, dizziness, fatigue, and rhinitis, with predominantly medium effect sizes. CONCLUSIONS AND INFERENCES: Meal-related symptoms are common in youth with DGBIs, but do not appear to be associated with mucosal eosinophils and mast cell counts. The positive associations of duodenal mast cells with non-GI somatic complaints suggest future studies should determine whether treatments targeting mast cells are beneficial for ameliorating these symptoms in youth with DGBIs.