Duodenal eosinophilia and the link to anxiety: a population-based endoscopic study

Jukka Ronkainen, Pertti Aro, Mike Jones, Marjorie M. Walker, Lars Agréus, Anna Andreasson, Nicholas J. Talley*

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    8 Citations (Scopus)


    Introduction: The concept of gut-to-brain communication via microbial or inflammatory pathways is gaining increased attention but genuine pathology directly linking gut perturbation to anxiety is lacking. We hypothesized that duodenal eosinophilia, as known to occur in functional dyspepsia (FD), may be an underlying cause of anxiety and may help explain the striking association between FD and anxiety. 

    Methods: Randomly selected subjects from the national population register of Sweden completed the validated Abdominal Symptom Questionnaire; 1000 completed esophagogastroduodenoscopy and the Hospital Anxiety and Depression Scale questionnaire. Duodenal biopsies were obtained from 1st (D1) and 2nd portion (D2). Eligible subjects who underwent endoscopy (n = 887) were invited to participate in a 10-year follow-up study with the same questionnaires. Among endoscopy normal subjects, FD was identified by Rome criteria, and controls were symptom free. Duodenal eosinophilia was based on pre-defined cut-offs. Finding are reported as odds ratios (ORs) with 95% confidence interval and p-value. 

    Results: The study population comprised 89 cases with FD and 124 healthy controls (mean age 62 years, SD 12, 34% male). Clinical anxiety at follow-up was elevated in those with D1 eosinophilia at baseline considering either new-onset anxiety (OR = 4.5, 95% CI 0.8, 23.8; p = 0.08) or follow-up anxiety adjusting for baseline anxiety (OR = 4.51 (95% CI 1.03, 19.81; p = 0.046). 

    Conclusion: Duodenal eosinophilia may potentially be a mechanism linked to anxiety independent of FD.

    Original languageEnglish
    Article numbere14109
    Pages (from-to)1-7
    Number of pages7
    JournalNeurogastroenterology and Motility
    Issue number10
    Early online date9 Mar 2021
    Publication statusPublished - Oct 2021


    • anxiety
    • duodenal eosinophilia
    • duodenum
    • eosinophils
    • functional dyspepsia


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