Collins Margaret H, Capocelli Kelley, Yang Guang-Yu
Division of Pathology and Laboratory Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, OH, United States.
Front Med (Lausanne). 2018 Jan 15;4:261. doi: 10.3389/fmed.2017.00261. eCollection 2017.
Eosinophilic gastrointestinal disorders (EGID) are characterized pathologically by excess eosinophils in mucosal biopsies of one or multiple sites in the gastrointestinal (GI) tract, simultaneously or sequentially. Eosinophilic esophagitis (EoE) is the best characterized EGID, and in most patients it is an abnormal immune-mediated response to food antigens. Current recommendations for diagnosis include signs and symptoms of esophageal dysfunction that do not respond to proton-pump inhibitor therapy, and esophageal biopsies that exhibit at least 15 intraepithelial eosinophils in at least one high power field (HPF). Therapy consists of swallowed glucocorticoids or dietary elimination. Eosinophilic gastritis (EG) is the second most common form of EGID, but like all forms of EGID except EoE consensus recommendations for either clinical or pathological diagnosis do not exist. EG may be associated clinically with peripheral blood eosinophilia, hypoalbuminemia, and anemia, and pathologically with marked expansion of lamina propria by dense eosinophilic infiltrates. Eosinophilic enteritis (EE) may be subdivided into eosinophilic duodenitis, eosinophilic jejunitis, and eosinophilic ileitis. Most investigators believe that EE rarely, if ever, exists as a solitary form of EGID and is encountered only in patients who have at least one other affected portion of the GI tract. Eosinophilic colitis (EC) is perhaps the most enigmatic EGID. Distinction of EC from inflammatory bowel disease may be problematic especially in children. Multiple possible etiologies for EGID include hypereosinophilic syndrome, drug reactions, etc. Currently, the only etiology that can be identified histologically is parasitic infestation, if a portion of an invasive parasite is found in mucosal biopsies. This review will provide guidelines for the pathologic diagnosis of the various forms of EGID.
嗜酸性粒细胞性胃肠疾病(EGID)的病理特征是胃肠道(GI)一个或多个部位的黏膜活检中嗜酸性粒细胞增多,可同时或相继出现。嗜酸性粒细胞性食管炎(EoE)是特征最明确的EGID,在大多数患者中,它是对食物抗原的异常免疫介导反应。目前的诊断建议包括质子泵抑制剂治疗无效的食管功能障碍的体征和症状,以及在至少一个高倍视野(HPF)中显示至少15个上皮内嗜酸性粒细胞的食管活检。治疗方法包括吞咽糖皮质激素或饮食排除法。嗜酸性粒细胞性胃炎(EG)是EGID的第二常见形式,但与除EoE之外的所有EGID形式一样,不存在临床或病理诊断的共识性建议。EG在临床上可能与外周血嗜酸性粒细胞增多、低白蛋白血症和贫血有关,在病理上与固有层因密集的嗜酸性粒细胞浸润而显著扩张有关。嗜酸性粒细胞性肠炎(EE)可细分为嗜酸性粒细胞性十二指肠炎、嗜酸性粒细胞性空肠炎和嗜酸性粒细胞性回肠炎。大多数研究者认为,EE极少作为一种单独的EGID形式存在,仅在胃肠道至少有一个其他受累部位的患者中出现。嗜酸性粒细胞性结肠炎(EC)可能是最神秘的EGID。将EC与炎症性肠病区分开来可能存在问题,尤其是在儿童中。EGID的多种可能病因包括高嗜酸性粒细胞综合征、药物反应等。目前,组织学上唯一能确定的病因是寄生虫感染,如果在黏膜活检中发现部分侵袭性寄生虫的话。本综述将提供各种形式EGID病理诊断的指导原则。
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