University of Oulu

Ronkainen, J., Aro, P., Jones, M., Walker, M.M., Agréus, L., Andreasson, A. and Talley, N.J. (2021), Duodenal eosinophilia and the link to anxiety: A population-based endoscopic study. Neurogastroenterology & Motility, 33: e14109.

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

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Author: Ronkainen, Jukka1,2; Aro, Pertti3; Jones, Mike4;
Organizations: 1Center for Life Course Health Research, University of Oulu, Oulu, Finland
2Primary Health Care Center, Tornio, Finland
3Arokero OY, Tornio, Finland
4Macquarie University, North Ryde, NSW, Australia
5Priority Research Centre for Digestive Health and Neurogastroenterology, Faculty of Health and Medicine, Universityof Newcastle, Newcastle, Australia
6Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, Australia
7Division of Family Medicine and Primary Care, Division of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
8Stress Research Institute, Stockholm University, Stockholm, Sweden
9Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
Persistent link:
Language: English
Published: John Wiley & Sons, 2021
Publish Date: 2022-03-09


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).

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

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Series: Neurogastroenterology & motility
ISSN: 1350-1925
ISSN-E: 1365-2982
ISSN-L: 1350-1925
Volume: 33
Issue: 10
Article number: e14109
DOI: 10.1111/nmo.14109
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
3124 Neurology and psychiatry
Funding: This study was supported in part by the Swedish Research Council, the Swedish Society of Medicine, Norrbotten County Council (Sweden), Astra Zeneca R&D (Sweden), Orion Research Foundation (Finland), the Finnish Medical Foundation (Finland), the Finnish Society of Medicine Duodecim, Vappu and Oskari Yli-Perttula's Foundation (Finland) and the National Health and Medical Research Council (NHMRC) of Australia (Grants NHMRC APP1061004, and NHMRC APP1084544).
Copyright information: © 2021 John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Ronkainen, J., Aro, P., Jones, M., Walker, M.M., Agréus, L., Andreasson, A. and Talley, N.J. (2021), Duodenal eosinophilia and the link to anxiety: A population-based endoscopic study. Neurogastroenterology & Motility, 33: e14109, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.