Han X X, Guan D X, Zhou J, Yu F H, Wang G L, Mei T L, Guo S, Fu L B, Zhang J, Shen H Q, Xu X W
Department of Gastroenterology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Faculty of Digestive Diseases, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100045, China.
Zhonghua Er Ke Za Zhi. 2018 Jul 2;56(7):500-504. doi: 10.3760/cma.j.issn.0578-1310.2018.07.006.
To summarize the clinical data including manifestations, diagnosis, treatment and prognosis of eosinophilic gastroenteritis (EGE) in children. A retrospective analysis was performed in 71 patients with pathologically proven EGE at Beijing Children's Hospital Affiliated to Capital Medical University from January 2008 to January 2017. Their clinical manifestations, laboratory and imaging examinations, endoscopic findings, histopathological examinations, and treatment were collected and analyzed. Among 71 EGE cases, 47 (66%) cases were male and 24 (34%) cases were female, and the median age was 9.2 (0.2-16.5) years old. The main clinical manifestations included abdominal pain (76%, 54/71), vomiting (68%, 48/71), anorexia (54%, 38/71), weight loss (38%, 27/71), and diarrhea (37%, 26/71). There were 27 cases (38%) with a history of allergic diseases or family history. The median absolute value of eosinophil in peripheral blood of the 71 patients was 0.4 (0-36.8)×10(9)/L, and 27 cases (38%) showed an increase in eosinophil counts. Serum IgE was measured in 52 patients (104.3 (3.4- 3 000.0)×10(3) U/L), and 30 patients (58%) showed an increase in serum IgE. A large number of eosinophils ((41.0±8.5)/HP) were found in 3 patients' ascites. The endoscopic examination of upper gastrointestinal tract revealed hyperemic edema in 62 cases (87%), plaque in 44 cases (62%), erosion in 17 cases (24%) and ulceration in 16 cases (23%). Histopathologically, in 8 cases (11%) the disease involved both stomach and duodeneum, in 21 cases (30%) involved stomach only, and in 37 cases (52%) involved duodeneum only. In addition, in 6 cases (8%) the disease involved esophagus and in 10 cases (14%) involved colorectum. Microscopically, eosinophil counts averaged 67/HP, 33/HP, 40/HP and 38/HP in esophageal, gastric, duodenal and colorectal mucosa respectively. A total of 34 cases were treated with glucocorticoid, and all these patients had alleviation of symptoms, which occurred within 14.9 days on average, but EGE recurred in 11 cases (32%). The clinical symptoms and endoscopic findings of EGE are diverse and nonspecific. Histopathological examination of gastrointestinal mucosa is particularly important for the diagnosis. Glucocorticoid treatment is effective, but the patients with EGE are prone to relapse.
总结儿童嗜酸性粒细胞性胃肠炎（EGE）的临床表现、诊断、治疗及预后等临床资料。对2008年1月至2017年1月首都医科大学附属北京儿童医院71例经病理证实的EGE患者进行回顾性分析。收集并分析其临床表现、实验室及影像学检查、内镜检查结果、组织病理学检查及治疗情况。71例EGE患者中，男性47例（66%），女性24例（34%），中位年龄9.2（0.2 - 16.5）岁。主要临床表现包括腹痛（76%，54/71）、呕吐（68%，48/71）、厌食（54%，38/71）、体重减轻（38%，27/71）及腹泻（37%，26/71）。有27例（38%）有过敏性疾病史或家族史。71例患者外周血嗜酸性粒细胞绝对值中位数为0.4（0 - 36.8）×10⁹/L，27例（38%）嗜酸性粒细胞计数升高。52例患者检测血清IgE（104.3（3.4 - 3000.0）×10³U/L），30例（58%）血清IgE升高。3例患者腹水发现大量嗜酸性粒细胞（（41.0±8.5）/HP）。上消化道内镜检查显示62例（87%）充血水肿，44例（62%）有斑块，17例（24%）糜烂，16例（23%）溃疡。组织病理学检查，8例（11%）病变累及胃和十二指肠，21例（30%）仅累及胃，37例（52%）仅累及十二指肠。此外，6例（8%）累及食管，10例（14%）累及结直肠。镜下食管、胃、十二指肠及结直肠黏膜嗜酸性粒细胞计数平均分别为67/HP、33/HP、40/HP和38/HP。34例患者接受糖皮质激素治疗，所有患者症状均缓解，平均缓解时间为14.9天，但11例（32%）复发。EGE的临床症状和内镜检查结果多样且无特异性。胃肠道黏膜组织病理学检查对诊断尤为重要。糖皮质激素治疗有效，但EGE患者易复发。
