The Clinical Research Of Refractory Peptic Ulcers Due To Eosinophilic Gastroenteritis

Objective:To investigate the clinical characteristics, diagnosis, treatment and prognosis of the patients had eosinophilic gastroenteritis (EGE) with the features of refractory peptic ulcers.Methods:A total of 4 EGE patients which performed as refractory peptic ulcers in the First Affiliated Hospital of Collage of Medicine, Zhejiang University from January 2013 to March 2016 were retrospectively analyzed. Meanwhile, the relative data of 12 similar cases reported in our country were also collected and analyzed.Results:The patients of EGE with the manifestation of peptic ulcer can occur at any age with the average of 26.38±16.15 years old. And the patients were commonly males with the sex ratio of 3:1. Only 37.5%(6/16) showed a simple mucosal subtype, and the rest were combined with muscular or (and) serosal type. The three main symptoms were abdominal pain (81.25%), nausea and vomiting (43.75%) and diarrhea (43.75%) according to different subtypes. Among the 16 EG patients,5 cases were associated with allergic constitution. The peptic ulcers in EGE patients were most common in duodenum, accounting for 43.75%(7/16), followed by the gastric antrum and pylori, which accounted for 37.5%(6/16) and 18.75%(3/16) respectively.22.22%(2/9) patients had the history of Helicobacter pylori infection. Peripheral blood eosinophil (EOS) count increased in 75%(9/12) patients, and decreased significantly after therapy when analyzing in the method of paired t test (P<0.01, n=5). Imaging examinations were not specific, most of them manifested with obstruction and effusion.62.5%(10/16) patients were misdiagnosed during the initial visit. The causes of misdiagnosis were general gastrointestinal ulcer, chronic gastritis and duodenitis (7/10), digestive tract tumor (2/10) and acute appendicitis (1/10). Glucocorticoid was considered as the first-line drugs for the treatment, and it can quickly relieve in most cases. However, the relapse can happen, especially in those patients who stop taking medicine voluntarily or reduce to low dose. The majority of patients have a good prognosis. All cases have not been reported with carcinogenesis.Conclusion:EGE showed non-specific clinical symptoms and endoscopic appearance, so it can be easily misdiagnosed. Multiple endoscopic biopsies combined with other laboratory examinations such as routine blood test, the serum level of IgE, bone marrow puncture and imaging, as well as detailed questioning of allergic history can help to improve the rate of the disease first diagnosed.