University of Trieste, Trieste, Italy.
Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
Ital J Pediatr. 2019 Jun 6;45(1):69. doi: 10.1186/s13052-019-0661-7.
Eosinophilic gastrointestinal disorders (EGID) are characterized by eosinophilic inflammation and are subclassified according to the affected site(s) as eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis and eosinophilic colitis. Clinical presentation includes dyspeptic symptoms, vomiting, abdominal pain, diarrhoea and gastrointestinal bleeding. Peripheral eosinophilia is usually found but is not required for the diagnosis. The treatment is based on dietary elimination therapy, consisting of removal of common food triggers, most frequently cow's milk in infants. Corticosteroids are used as first line drug therapy in EG if dietary therapy fails to achieve an adequate clinical response or is impractical.
A four month old infant was admitted for an episode of melena and hematemesis. An esophagogastroduodenoscopy showed haemorrhagic gastritis with ulcerative lesions and fibrin. A significant gastric bleeding was noted after the procedure. The gastric mucosa biopsies showed an eosinophilic infiltration.
A clinically relevant anaemia is a quite rare complication in infants with eosinophilic gastritis and a biopsy may worsen bleeding, to a potentially severe level of low haemoglobin. In infants with low haemoglobin levels and suspect eosinophilic gastritis a watchful follow up after the biopsy should be considered, as well as the possibility of postponing the biopsy to reduce the bleeding risk.
嗜酸性粒细胞性胃肠道疾病（EGID）的特征是嗜酸性粒细胞炎症，并根据受累部位分为嗜酸性食管炎、嗜酸性胃炎、嗜酸性肠炎和嗜酸性结肠炎。临床表现包括消化不良症状、呕吐、腹痛、腹泻和胃肠道出血。外周血嗜酸性粒细胞增多通常存在，但并非诊断所必需。治疗基于饮食消除疗法，包括去除常见的食物诱因，婴儿中最常见的是牛奶。如果饮食疗法未能达到足够的临床反应或不切实际，则在 EG 中使用皮质类固醇作为一线药物治疗。
一名四个月大的婴儿因黑便和呕血入院。食管胃十二指肠镜检查显示出血性胃炎伴溃疡性病变和纤维蛋白。术后注意到明显的胃出血。胃黏膜活检显示嗜酸性粒细胞浸润。
在患有嗜酸性胃炎的婴儿中，临床相关贫血是一种相当罕见的并发症，活检可能会加重出血，导致潜在的严重低血红蛋白水平。对于血红蛋白水平低且怀疑患有嗜酸性胃炎的婴儿，应考虑在活检后进行密切随访，并考虑推迟活检以降低出血风险。
