| ObjectiveEosinophilic gastroenteritis(EGE)is a rare immune-mediated chronic gastrointestinal inflammatory disease characterized by a large number of eosinophils infiltrating various layers of the gastrointestinal tract.In recent years the incidence of the disease is gradually increasing,but the clinical manifestations of EGE are non-specific,and are easily misdiagnosed and missed.This article retrospectively analyzes the clinical characteristics and treatment of 96 EGE patients,in order to improve the understanding of the disease,further improve its early diagnosis rate.MethodsA total of 96 EGE diagnosed during the period from January 2015 to December 2019 in the First Affiliated Hospital of Zhengzhou University were collected,and their clinical symptoms,laboratory examination characteristics,imaging findings,endoscopy,histopathology,treatment and prognosis were analyzed.Results1 General information:Among the 96 EGE patients,male patients are more common,the male to female ratio is 1.4:1,the average age is 43.0±11.2 years,and the most common are those between 30 and 50 years old,with 47 cases(49.0%).There were 81 cases(84.4%)of mucosal type and 15 cases(15.6%)of mixed type(also involving the serosa and mucosa),The average age of mucosal type patients is higher than that of mixed type(also involving the serosa and mucosa).2 Allergy history and inducement:24 cases(25.0%)had a history of food or drug allergy;12 cases(12.5%)were combined with other allergic diseases.A female patient had both episodes during pregnancy.3 Clinical manifestations:The main clinical manifestation is abdominal pain(87.5%),abdominal distension(46.8%),diarrhea(20.8%),nausea and vomiting(28.1%),a few of black or bloody stool(7.3%),fever(2.1%).4 Laboratory examination:75 cases(78.1%)had increased eosinophilc granulocytes counts in peripheral blood,mixed type(also involving the serosa and mucosa)patients had a higher rise than mucosal type patients(P<0.05),and mucosal type patients showed a mild to moderate increase,mixed type(also involving the serosa and mucosa)patients showed a severe increase.7 cases(7.3%)Hb decreased,8 cases(8.3%)ALB decreased;45 cases completed serum IgE detection,28 cases(62.2%)increased,no correlation was found between peripheral blood eosinophil counts and serum IgE level;68 cases completed food allergen testing,44 cases(64.7%)with positive results,the most common allergen is egg;ascites was exudate in 15 patients with mixed type(also involving the serosa and mucosa),and a large number of eosinophils were found in pathology;51 cases completed bone marrow cytology examination,and 46 cases(90.2%)had increased eosinophilc granulocytes counts.5 Imaging examination:68 cases underwent abdominal CT,20 cases without abnormalities(29.4%),common abnormalities were thickening of the digestive tract wall in 19 cases(27.9%),and abdominal lymphadenopathy in 18 cases(26.5%).Patients with mixed type(also involving the serosa and mucosa)are more likely to show thickening of the gastrointestinal canal wall than patients with mucosal type(P<0.05).6 Endoscopy:Ninety patients underwent gastroscopy and 17 patients(18.9%)without obvious abnormalities;73 patients underwent colonoscopy and 43 patients(58.9%)without obvious abnormalities.The most common abnormalities under endoscopy are erosion and congestive edema.7 Histopathology:The positive rate of biopsy in the duodenum,ileocele and terminal ileum is higher.8 Treatment:68 patients(70.8%)in the hormonal treatment group and 28 patients in the non-hormonal treatment group(29.2%,including 9 cases of loratadine,1 case of ketotifen,and 18 cases of symptomatic acid suppression)improved clinical symptoms.The peripheral blood eosinophil counts in the hormone treatment group were more significantly decreased than that in the non-hormonal treatment group.9 Prognosis:69 cases were successfully followed up,18 cases(26.1%)relapsed,and most of them were accompanied by peripheral blood eosinophil counts increased again,hormone therapy is still effective.Conclusions1.The clinical manifestations of EGE are non-specific,and abdominal pain is the most common symptom.2.Most patients are accompanied by elevated peripheral blood eosinophil counts;no correlation was found between peripheral blood eosinophil counts and serum IgE level;patients with serosa involvement have a higher level of eosinophilc granulocytes in peripheral blood than patients with mucosal type.3.It is easier to obtain positive pathological results by taking biopsies from the duodenum,the terminal ileum and the ileocecal area.4.The effects of hormone and loratadine treatment are good,but there is a possibility of recurrence.When recurrence,the level of eosinophilc granulocytes in peripheral blood increase again. |
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