| Background:Whatever gastroenterology expert, allergy specialist, or immunology specialist, may encounter such patients in their clinical practices, who have Eosinophilic gastrointestinal disease (EGD). Eosinophils gastrointestinal disease includes Eosinophilic esophagitis (EoE), Eosinophilic gastroenteritis (EG), and Eosinophilic colitis (EC). It is characterised gastronintestinal tract inflammation symptom and pathological tissue infiltration with eosinophilis. With the widespread of electronic gastroendoscopy and colonoscopy examination, people have more and more knowledge about EGD, and reports about EGD is increasing around the world, especially EG and EC, more apparently in western developed country. Up to now, reports about EoE is still rare, especially in children, but it is still need further research to understand whether due to low incidence of the disease or the lack awareness of the disease and always misdiagnosis.EoE is a chronic immune-mediated esophageal disease. It was first reported by Landres et al in 1978, while the first report about children was by Kelly in 1995. After then foreign literature reports especially in western developed countries increase gradually, and a Meta-analysis from Soon’s report showed the incidence of EoE in children increased from 0.2/100000 to 43/100000 in recent twenty years. Due to differences in geographical location, the incidence of EoE in children is not same, and the current domestic reports of EoE in children is rare, so the true incidence of EoE is not clear. During the past decades, although many literatures reported the etiology and pathogenesis of EoE, but it is unclear. To a certain extent, it may be associated with allergy response, and the pathogenesis of EoE is very complex, involving genetic, immunological and environmental factors. It can present at any age with a diverse range of symptoms. The main symptoms complained by adult patients are dysphagia and food impaction and it is easy to identify. However, the clinical symptoms of EoE in children are lack of specificity, and always confuse with gastroesophageal reflux diseases (GERD), so it is easy to be misdiagnosed. Electronic gastroendoscopy and histopathological examination are golden standard to diagnose EoE. Early diagnosis and treatment in children is critical to the prognosis of EoE, avoiding serious consequences of esophageal fibration and stenosis, so it is important to improve our understanding about EoE in children.Objective:To analyze the clinical features and the diagnosis and treatment advance of EoE in children by case analysis and literature review.Methods:A retrospective analysis was performed on clinical presentation, laboratory test results, gastroendoscopy and histopathological examination features and treatment of 22 children with EoE from January,2011 to December,2015. Systematically search literature and review similar case reports to summarize the clinical features.Results:(1)Clinical date:To analysis the age distribution of 22 children with EoE in our study, the youngest patient is 5 months old, and the oldest patient is 13 years old. So EoE can occur at any age in children. The most common clinical manifestation of EoE is vomiting and abdominal pain (45.4% and 40.9%, respectively), and also these patients had other complaints such as regurgitation, nausea, haematemesis, poor appetite and so on.(2)Endoscopy and pathological features of esophageal mucosa:ll cases have mucous membrane coarse (50%),6 cases have congestion or erosion of esophageal membrane (27.3%),5 cases have longitudinal crack (22.7%),3 cases have ring uplift (13.6%),3 cases have granular uplift (13.6%),3 cases have normal mucosa(13.6%). Histopathologic manifestation is eosinophil infiltration, and the eosinophil count is all more than or equal 15/HP.(3)Laboratory results:1 case’s WBC was raised, and 13 cases have increasing eosinophil count and eosinophils proportion (61.9%).(4)Allergy history:among the 7 of 22 cases have allergy history(31.8%),4 cases have Allergic rhinitis (AR) history, and 2 cases have bronchial asthma history and 1 case have history of cephalosporin’s drug allergy. On the other hand,1 of 7 cases described above has cow’s milk allergy, and 2 patients have cow’s milk and egg allergy, and 2patients have pollen allergy.(5) Situation of treatment and remission:16 cases had clinical remission by oral Omeprazole; 2 cases had clinical remission by oral Omeprazole and Montelukast sodium; 1 case still had abdominal pain and arthragia after using antibiotics and Cimetidine, but he lost to follow-up; 1 case had not remission after using Talcid and ChangWeiKang granule and dropped out; 1 case acquire remission by elimination diet of fish, macrura, egg and cow’s milk and changing the formula; 1 case acquire remission by elimination diet of fish, macrura, egg and cow’s milk and oral prednisone. Only 2 patients received gastroendoscopy re-examination after three months, and revealed esophageal mucosal histologic complete recovery.Conclusions:The clinical symptoms of EoE in children are always various, and vomiting and abdominal pain is very common. Patients with EoE also complain haematemesis, regurgitation, belching, poor appetite and so on, but dysphagia and food impaction are rare. Esophageal mucosal features of gastroendoscopy examination in children with EoE have the longitudinal crack, white exudates or plaques, paper mucosa, ring uplift and granular uplift, even esophageal ring and esophageal stenosis in severe cases. The diagnosis of EoE depend on the collection of medical history in detail (including allergy history), combination gastroendoscopy and histological examination, especially eosinophil count. Most patients could obtain remission by using Proton-pump inhibitors, and sometimes PPI plus anti-allergic drug for definite allergy history, only few children need elimination diet and change formula, even oral glucocorticoids. |
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