| Objective:To study the clinical and pathological features of eosinophilic gastroenteritis(EG)in children and to improve the understanding of EG in children.Methods:The age of onset,etiology,clinical manifestations,peripheral blood eosinophil(Eosinophils,EOS)count and ratio,hemoglobin level,food allergen Ig E and food intolerance Ig G,H.pylori,gastroscopic and pathological mucosal biopsies were collected from January 1,2020 to December 31,2021 in children with EG diagnosed in Jiangxi Children’s Hospital due to gastrointestinal symptoms.Helicobacter,gastroscopic manifestations and pathological features,and compared with those of children with chronic gastritis and peptic ulcer diagnosed at the same time and statistically analyzed.Children with chronic superficial gastritis on gastroscopy and confirmed EG on pathological examination were classified as EG(gastritis)group,while children with ulcer on gastroscopy and confirmed EG on pathological examination were classified as EG(ulcer)group.Children diagnosed with chronic superficial gastritis were assigned to the chronic gastritis group,and children diagnosed with peptic ulcer were assigned to the peptic ulcer group.Results:1.General data:A total of 927 children were collected,with a median age of onset of 8(5,11)years and a minimum age of 0.25 years,with a male to female ratio of 1.9:1.There were 84 cases of EG,including 54 cases in the EG(gastritis)group with a median age of onset of 9(4,11)years and a minimum age of 0.25 years,with a male to female ratio of 2.4:1;30 cases in the EG(ulcer)group with a median age of onset of 11(10,13)years and a minimum age of 6 years,with a male to female ratio of6.5:1;541 cases in the chronic gastritis group with a median age of onset of 7(5,9)years and a minimum age of 0.33 years,with a male to female ratio of 1.4:1;There were 302 cases in the peptic ulcer group with a median age of onset of 9(5,11)years and a minimum age of 0.58 years,with a male to female ratio of 5.7:1.Statistical analysis by Mann-Whitney U test showed no statistically significant differences between the EG(gastritis)and chronic gastritis groups and between the EG(ulcer)and peptic ulcer groups in terms of age at onset(P>0.05).2.Clinical manifestations:Among the 927 children,581/927(62.7%)had abdominal pain,78/927(8.4%)had abdominal distension,277/927(29.9%)had nausea and vomiting,and 299/927(32.3%)had vomited blood or black stool.By?~2test statistical analysis,the differences between the three clinical symptoms of abdominal pain,abdominal distension,and nausea and vomiting in the EG(gastritis)group and the chronic gastritis group,and the EG(ulcer)group and the peptic ulcer group were not statistically significant(P>0.05),while gastrointestinal bleeding was statistically significant in all cases(P<0.05).3.Laboratory tests:(1)Blood EOS,haemoglobin and CRP:The differences in the absolute values and percentages of EOS between the EG(gastritis)group and the chronic gastritis group and between the EG(ulcer)group and the peptic ulcer group were statistically significant(P<0.05).There was no statistically significant difference in CRP between the EG(gastritis)group and the chronic gastritis group and between the EG(ulcer)group and the peptic ulcer group(P>0.05).(2)Stool routine:No parasite eggs were detected in the stool routine of all children.(3)Allergy-related tests:by statistical analysis of the Mann-Whitney U test,the differences in total serum Ig E between the EG(gastritis)group and the chronic gastritis group,and between the EG(ulcer)group and the peptic ulcer group were not statistically significant(P>0.05).By?~2test statistical analysis,there was no statistically significant difference in food allergen Ig E between the EG(gastritis)group and chronic gastritis group,EG(ulcer)group and peptic ulcer group(P>0.05);there was no statistically significant difference in food intolerance Ig G between the EG(gastritis)group and chronic gastritis group,EG(ulcer)group and peptic ulcer group(P>0.05).4.Gastroscopy and pathological examination:By?~2test statistics and Fisher’s exact probability method analysis,there were statistically significant differences between the EG(gastritis)group and the chronic gastritis group in three endoscopic manifestations:esophageal mucosal congestion and edema,gastric mucosal erythema,and duodenal mucosal erythema(P<0.05),and there were no statistically significant differences between the endoscopic manifestations of the EG(ulcer)group and the peptic ulcer group(P>0.05).Among the children with EG,endoscopic biopsies suggested more EOS infiltrates per high magnification,with diffuse or multifocal distribution.By statistical analysis of the Mann-Whitney U test,the differences in the number of EOS per high magnification between the EG(gastritis)group and the chronic gastritis group,and between the EG(ulcer)group and the peptic ulcer group were statistically significant(P<0.05);the differences in the number of mast cells between the EG(gastritis)group and the chronic gastritis group,and between the EG(ulcer)group and the peptic ulcer group were not statistically significant(P>0.05).5.Helicobacter pylori(HP)infection:In the EG(gastritis)group,34/54 cases(63%)were positive for HP;in the chronic gastritis group,184/541 cases(34%)were positive for HP.26/30 cases(86.7%)were positive for HP in the EG(ulcer)group;239/302 cases(79.1%)were positive for HP in the peptic ulcer group.By?~2test statistical analysis,the difference in HP infection between children in the EG(gastritis)and chronic gastritis groups was statistically significant(P<0.05),while the difference in HP infection between the EG(ulcer)and peptic ulcer groups was not statistically significant(P>0.05).Conclusions:1.The age of onset of childhood EG peaks at school age(>6 years),with the youngest age being 0.25 years,and is more common in boys.2.The most common clinical manifestation of childhood EG is abdominal pain.Compared with chronic gastritis,children with EG showing chronic superficial gastritis at endoscopy are more likely to have gastrointestinal bleeding.3.Increased peripheral blood EOS has some reference value for EG diagnosis,but cannot be used as a confirmatory criterion.4.Food allergy can induce EG,which may be related to non-Ig E-mediated mainly and Ig E-mediated supplementary allergic reactions.5.The etiology of EG in children is unknown,and HP infection may be related to the development of EG.6.Children with EG manifesting as chronic gastritis are more likely to show endoscopic signs of esophageal mucosal congestion and edema,gastric mucosal erythema and duodenal mucosal erythema,while children with EG manifesting as peptic ulcer have non-specific endoscopic manifestations.Pathological mucosal biopsy EOS count is the key to confirm the diagnosis,and mast cell count is of little value for diagnosis. |
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