Sa1297 The Degree of Mucosal Damage to the Small Intestine and Serum IgG4 Levels Correlate With Celiac Disease

Introduction and Aim: Duodenal eosinophilia has been previously described in subsets of patients with functional dyspepsia1 (FD), non-celiac wheat sensitivity2 and celiac disease (CD)3. CD has varied clinical presentations, including symptoms of functional gastrointestinal disorders (FGIDs), FD and irritable bowel syndrome (IBS). We aimed to determine if duodenal eosinophilia is present in patients with CD presenting with dyspepsia. Methods: The celiac study population comprised 61 patients, 44 female, mean age 42, (range 17-74) years with a new presentation of subsequent biopsy proven coeliac disease to a single centre from 2003-13. A standard symptom questionnaire was documented for all patients. The control population (53 adults) presenting for endoscopy with no CD was drawn from the same centre with similar demographics for age and gender1. Duodenal biopsies from both groups were assessed for eosinophil counts/ mm2. Results: In patients with coeliac disease 37/61 (60%) had symptoms of a FGID, 9 FD, 17 IBS, 11 overlap FD and IBS. 15 (71% of FD) had early satiety (ES) symptoms, 19 with reflux symptoms. In controls 33/53 (64%) had symptoms of FD, 17 (51%) with ES, 21 IBS. Early satiety was an equally common presentation in celiac and control patients. IBS was more common in celiac patients (p= 0.01). See Table. Compared to a similar population from the same hospital, duodenal eosinophils are significantly raised in CD compared to a group without coeliac disease attending for endoscopy, mean 45/mm2 vs 65/mm2 p=0.005. Eosinophil counts were similar in control patients with symptoms of dyspepsia (mean 50/ mm2) and early satiety (ES) (mean 55/ mm2), compared to those with CD and dyspepsia (mean 47/ mm2), p=0.80 and CD and ES (mean 56/ mm2), p=0.87. In controls with no dyspepsia eosinophil counts were significantly lower (mean 40/ mm2) than those with CD and no dyspepsia (mean 70/ mm2), p=0.005. See Figure. Among control patients, 3 reported food allergies, 2 with ES all 3 with D2 eosinophilia. Conclusions: Duodenal eosinophilia in coeliac patients with dyspepsia and ES is of a similar level to patients without CD with FD and ES. As duodenal eosinophilia is described in non-celiac wheat sensitivity it is possible that eosinophils are a sign of wheat intolerance and suggests a wheat free diet may benefit certain FD patients if duodenal eosinophilia is present.