| Aim: To retrospectively analyze the clinical features of eosinophilic gastroenteritisin order to improve the understanding of the disease, provide clues for early diagnosisand treatment as well as reduce misdiagnosis.Methods: We retrospectively analyze the history of patients， the clinicalmanifestations，auxillary examination, endoscopic results，pathologica findings andtreatment in21patients who were diagnosed as eosinophilic gastroenteritis from2003to2013at The First Affiliated Hospital of DaLian University．Results:1. The general information:21cases with Eosinophilic Gastroenteritis wereincluded in the research of which9were males and12were females. The onset agewere13to77years old and the average ages of21patients were44.33±1.66yearsold.the duration of diease changed from2days to9years. Based on Klein’sclassification guidelines,21patients were divided into three groups including16ofmucosa in group Ⅰ,4of muscularis in group Ⅱ，and1of subserosa in group Ⅲ．Ingroup Ⅰ, male female ratio was1:1. The onset age were20to77years old and theaverage ages of group I were48.25±1.45years old.the duration of diease changed from2days to7years. In group Ⅱ, male female ratio was1:3. The onset age were19to51years old and the average ages of group Ⅱ were36.5±1.7years old.the duration ofdiease changed from half a year to5years. In group Ⅲ, one female patient’s onset age was13years old and the duration of diease was9years.2. The triggers and allergy: Tow patients have the food triggers.9patients fromgroup I and group Ⅲ gave a history of allergy such as food or drug allergy, asthma,rhinitis and skin allergy. Patients in group Ⅱ did not have a history of allergies.3. Clinical manifestations: All patients exhibit various clinical gastrointestinalsymptoms，and90.48%were abdominal pain, which mainly located in the upperabdomen followed by periumbilical. Patients from group Ⅱ and group Ⅲ presentedwith abdominal pain and distension. Other clinical symptoms are anorexia (57.14%),nausea or vomiting (38.95%), diarrhea (38.95%), abdominal distension (28.57%),weight loss (23.81%) and fever (9.52%). Abdominal pain as starting symptomaccounted for71.43%, followed by diarrhea (19.05%), nausea or vomiting (4.76%)and abdominal distension (4.76%).4. Peripheral blood and Bone marrow examination: Nintheen patients hadperipheral eosinophilia, but the proportion of eosinophils increased in allpatients.Group Ⅱdid not present a comparably higher number of peripheral eosinophiliathan group Ⅰ（P＞0.05）.11patients were diagnosed as eosinopils, presenting12.5-41%of eosinophilia and majority of mature stage by bone marrow examination.5. Serologic test: Among21EG patients, there were14cases with globulin decline.5cases from group Ⅱ and group Ⅲ increased out of11cases of assay of serum CA125.14patients tested erythrocyte sedimentation rate and8patients tested C-reactive proteinwere normal.5cases detected serum IgE with4elevated. Antinuclear antibodies,anti-ENA antibody spectrum and rheumatoid factor are normal.6. Ascites check：The proportion of eosinophils were60-95%which were found inascitic fluid of5patients from group Ⅱ and group Ⅲ.7. Endoscopic and histologic examination: there were18cases of gastritis and1case of gastric antrum ulcer, performing hyperemia,edema,hyperplasia and erosion,included in19cases underwent gastroscopy. There were6cases of duodenal ulcerationor inflammation, performing hyperemia, hemorrhage, hyperplasia and ulcer under thegastroscopy, in19cases at the same time. There were4cases of esophagitis, performing the lower esophageal hyperemia, in19case at the same time.15casesunderwent gastroscopic mucosal biopsy with a lot of eosinophil infiltrated in11casesincluding8cases of stomach and3of duodenum. There were15cases examined withHP in19cases with9case of positive and6cases of negative. there were8cases ofcolitis,3case of proctitis and1case of normal included in12cases underwentconlonoscopy. Performance for conlonoscopy were congestion, edema, erosion orpolyps in colon and congestion,edema or hyperplasia in rectum.11cases underwentconlonoscopic mucosal biopsy with a lot of eosinophil infiltrated in6cases including5cases of colon and1of rectum.8. Auxillary examination：There were19cases performing abdominal computertomography or magnetic resonance imaging which demonstrated5cases of ascites,2cases of gastric antrum thickening and2cases of small intestinal thickening. The erectabodominal radiograph showed a small amount of pneumatosis in small intestinal andsmall liquid flat in2cases. Lung computer tomography showed a small amount ofpleural effusion in2cases.9. Treatment:12patients were treated with non-steroids in the beginning resultingin1case without clinical manifestations relief and3cases with steroids later. Theperipheral eosinophil count before and after non-steroids therapy were （5.36±4.96）×109/L and（0.77±0.87）×109/L respectively and the average interval between before andafter therapy were6.5±3.06days.Compare with the peripheral eosinophil count beforetherapy, the peripheral eosinophil count after therpy moderately declined (P＞0.05).9out of21EG patients required treatment with steroids resulting in completely clinicalmanifestations relief in all cases.The peripheral eosinophil count before and aftersteroids therapy were （4.47±3.74）×109/L and （3.31±4.52）×109/L respectively andthe average interval between before and after therapy were6.3±1.58days..Comparewith the peripheral eosinophil count before therapy, the peripheral eosinophil countafter therpy obviously fell (P＜0.05) within5or7days. One out of9patients treatedwith steroids came out peripheral eosinophil count elevation in the course of steroidsreduction and one patient relapsed after the steroids taper yet respond to repeated steroids treatment.Conclusion:1. Presentation in EG lack specificity. For the patients with abdominal pain,anorexia, nausea or vomiting, and diarrhea, a high degree of clinical suspicion,especially in patients with peripheral eosinophilia, will aid to establish the diagnosis.2.The mucosal form is more common in the classification.3.Most of the patients with EG present peripheral eosinophilia. the peripheraleosinophil count was normal in a minority of cases.4.Ascites is the main performance in subserosal form and ascites with significanteosinophilia is helpful for the diagnosis.5.The endoscopic appearance including oedema,congestion and erosion isnonspecific.The stomach is the sites most commonly affected.6.Steroids remain the mainstay of therapy for eosinophilic gastroenteritis，and theeffect is well．Relapse can occur after steroids therapy. |
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