Evaluation of Gastro-Duodenal Mucosa of Non-IBS / Non-Endoscopic EGD Disorders in Metabolic Syndrome

Abstract

Background: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder, while metabolic syndrome (MetS) may contribute to gastrointestinal disturbances and microscopic mucosal inflammation (microscopic gastroduodenitis).

Aim: to assess the histopathologic and histochemical changes of gastroduodenal mucosa in the expected nonorganic disorders as diagnosed by endoscopy and in non-IBS (IBS-like+IBS-free) GIT disorder of patients with MetS.

Patients and Methods: A total of 839 patients attended the GIT endoscopy unit over a three-year period were categorized into two groups: those with gastroduodenal diseases (n=510) and those with no endoscopic abnormalities (n=329). Patients with no endoscopic abnormality were divided into four groups: I, IBS without MetS (n=39); II, IBS with MetS (n=53); III, non-IBS with MetS (n=158); and IV, non-IBS without MetS (n=79). Gastroduodenal biopsies were obtained and examined histopathologically using hematoxylin and eosin staining.

Results: Gastric lymphocytic cellular infiltration (LCI) differed significantly among groups (p < 0.001), with higher grades predominantly observed in Group II. Gastric eosinophilic cellular infiltration (ECI) also differed significantly (p < 0.001), with higher infiltration in Groups II and III. Duodenal LCI differed significantly (p = 0.034) in Group II compared with Groups I and IV. Duodenal ECI showed a highly significant difference (p < 0.001), with greater infiltration in Groups II and III compared with Groups I and IV.

Conclusion: Metabolic Syndrome is associated with increased gastroduodenal mucosal lymphocytic and eosinophilic infiltration, particularly among patients with IBS, suggesting a microscopic inflammatory process underlying the apparently functional gastrointestinal symptoms.