| Background&Aim:Eosinophilic gastroenteritis (EG) is an uncommon eosinophilic gastrointestinal disorders. Although the prevalence and diagnostic rate of EG has been improved in recent years, the misdiagnosis is still common. The aim of this paper is to analyze the clinical characteristics, diagnosis, treatment and prognosis of EG, and to evaluate the possible misdiagnosis reason.Methods:Patients from provincial hospital affiliated to shandong university, from February2003to February2013, with a diagnosis of EG were studied and reviewed, including16cases of EG that confirmed diagnosis by Tally standard finally and the orther group of6patients with unexplained gastrointestinal symptoms and peripheral eosinophilia, but no evidence of eosinophils infiltration of the gut wall and other diseases been excluded. The general clinic data of22patients were summarized and analyzed. Tally diagnosis standard and Klein classification are applied in this study, SPSS16.0software is used for statistical processing.Results:(1) The initial misdiagnosed rate was90.91%, two weeks misdiagnosis rate was50%.(2) Clinical characteristics:①It was found that68.18%of EG patients (22cases) had a history of allergies or positive result to food intolerance test, allergy history including food allergy(seafood and eggs, milk, etc) and antibiotics allergy(sulfanilamide and clarithromycin). Seven patients (31.82%) had a clear incentive. Eight cases with positive results to food intolerance test, the most common allergic food included crab and shrimp, followed by eggs, milk, and a few allergic to wheat.②clinical manifestation:Abdominal pain (20cases) accounting for90.91%,was the most common clinical manifestations, including abdominal pain cramps, vague abdominal pain, distending pain, paroxysmal abdominal cramps was the most common (68.18%). The other symptoms were nausea and vomiting, abdominal distension, weight loss, acid reflux and heartburn, skin rashes, diarrhea, defecation difficulties, ect.③according to Klein classification,22patients with EG type was divided into mucous type(16cases, accounted for72.3%), muscular type (3cases) and subserosal type (3cases), and clinical classification and clinical manifestations had close relationship. Mucous disease was mainly characterized by abdominal pain, diarrhea; muscular type mainly showed complete or incomplete gastrointestinal obstruction; subserosal type was charactered by eosinophilic ascites.④Auxiliary examination:Ⅰ. Blood routine:Peripheral blood leukocyte of22patients was (3.40～18.40) x109/L, the average (10.69±2.91) x109/L, the eosinophils (0.35～8.78) x109/L and the average (3.33±2.16) x109/L, among22patients,20cases with eosinophilia(accounted for90.91%).Three types had different eosinophils counts, mucous type (2.07±1.46) x109/L, muscular type (4.22±2.22)×109/L, subserosal type (5.61±2.11)×109/L, and subserosal type had a higher eosinophilia counts (p<0.05). Ⅱ. Serologic test:40%patients had blood elevated IgE,3cases of patients with elevated blood CA125, levels of139μ/L～706μ/L,2cases of patients with elevated blood CRP,2patients with moderately lower albumin,1case of slightly elevated blood amylase. Ⅲ. Ascites examination:Three cases with subserosal type showed ascites as extravasate with a large number of eosinophilss (ascites cytology of one misdiagnosed case reported more neutrophils in local hospital), Ⅳ. Imaging findings:CT showed nonspecific thickening of stomach or intestinal wall in3patients with muscular type. Ⅴ. Endoscopy and pathology:endoscopic performance was nonspecific with hyperaemia oedema, erythema, erosion, mucosal grainy, ulcer, bulge and so on. Endoscopic and pathology manifestations were inconsistent.⑤Treatment: eosinophils counts before and after the treatment in steroid therapy group (16cases) was (3.14±1.98)×109/L and (0.43±0.33)×109/L, the difference was statistically significant (p<0.05); the nonhormone treatment group (5cases) was (1.85±1.29)×109/L and (1.55±1.34)×109/L, there was no statistically significant difference (p>0.05).⑥Two patients with EG recurrence,steroid was still effective.Conclusions:EG is easy to be misdiagnosed because of its nnonspecific clinical performance. Diagnosed of EG is mainly baseded on clinical manifestation, laboratory examination, radiological abnormalities, endoscopic biopsy, pathological examination and treatment. Allergy history especially for food allergies and eosinophilia provide a clue to the diagnosis of EG. When gastrointestinal symptoms showed with or without peripheral blood eosinophilia, especially with a history of allergy, EG should be considered in differential diagnosis. Since the patchy distribution of eosinophils may lead to misdiagnosis, multiple biopsy should be taken (at least6pieces) from both the normal and abnormal appearing mucosa. Hormone therapy is superior to the diet therapy. In same cases, early hormone therapy can effectively avoid unnecessary surgical trauma. Recurrence may happen sometimes, while the prognosis is good. |
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