Clinical Analysis Of Children With Eosinophilic Gastroenteritis Manifested By Peptic Ulcer

Objective:To analyze the clinical features,laboratory examination,endoscopic findings,histopathological features,treatment and outcome of EG patients with peptic ulcer as the main manifestation,in order to improve the diagnosis and treatment of eosinophilic gastroenteritis in children with peptic ulcer,and to reduce missed diagnosis and misdiagnosis.Methods:A retrospective analysis was made of 28 children with eosinophilic gastroenteritis and peptic ulcer(gastric or duodenal ulcer)diagnosed in the Department of Gastroenterology of Jiangxi Children's Hospital from January 2014 to June 2019.clinical manifestations,laboratory examination,endoscopic manifestations,histopathological features,treatment and prognosis.Results:1.General data:A total of 28 children were included in the study,including 25males and 3 females,and the ratio of males to females was 8.33to1.The age ranged from 8 months and 17 days old to 14 years old,with an average age of(9.33±3.13)years.Among them,1 case was<1 year old(3.57%),1 case was 1 to 3 years old(3.57%),3 cases were 3 to 7 years old(10.71%),and 23 cases were>7 years old(82.14%).2.Clinical manifestations:Abdominal pain in 23cases(82.14%),pale complexion in 18 cases(64.29%),vomiting in 17 cases(60.71%),black stool in 15cases(53.57%),hematemesis in 8 cases(28.57%),fatigue in 8 cases(28.57%)and acid belching in 1 case(3.57%).Abdominal tenderness was found in 15 cases(53.57%).3.Laboratory examination:21 patients(75.00%)had a decrease in peripheral blood(Hb)(<110g/L),and 4 patients(14.29%)had an increased eosinophil(EoS)count(>0.47×10~9/L)with an average(0.35±0.50)×10~9/L(Comparative analysis of patients'blood EoS counts before and after treatment(t=-0.619,P=0.542));Ten patients had improved immunoglobulin assays,of which 5(50.00%)had increased immunoglobulin E(IgE).Twenty-one children had complete food allergy and food intolerance examinations,of which 10(47.62%)were positive for food-specific IgE and 14(66.67%)were positive for food-specific IgG(>100u/ml).Twelve patients(80.00%)were positive for serum H.pylori(Hp)antibody.All parasite eggs and tuberculin test results of fecal samples were negative.Eleven patients had complete bone marrow aspiration examinations,of which 7(63.64%)indicated hyperplastic bone marrow elephants,and the remaining 17 patients with family members rejected bone marrow aspiration examinations..4.Gastroscopy:All the 28 children were showed ulcers under gastroscopy,among which 23(82.14%)had duodenal ball lesions and ulcer,and 23(82.14%)had gastric antral mucosa hyperemia and edema.There were 5 cases of gastric ulcer(17.86%),including 3 cases involving gastric Angle,2 cases involving gastric antrum,5 cases involving mucosal hyperemia and edema in duodenal bulb(17.86%),and 3cases associated with erosion(10.71%).Among all the children,8 patients presented with giant ulcer(diameter?25mm),and the surface of the ulcer was covered with thick yellowish moss.5.Histopathological examination:Gastric antrum biopsy is mainly manifested as chronic inflammation of the mucosa,with a large amount of EoS infiltration.The Eos counts of 28 cases of hematoxylin-Gimsa-eosin staining(HGE staining)were all greater than 20/HPF(per high-power field of view)average(35.76±14.60)/HPF,and mast cell count by Csaba Alcian blue sand red staining showed mast cell infiltration,averagely(15.56±11.41)/HPF.17 cases(60.71%)of rapid urease test were positive.6.Treatment and outcome:In this group,20 cases were cured by diet avoidance,acid production and anti-Helicobacter pylori treatment,but not treated with hormone.The other 8 cases were reexamined by gastroscopy after 8 weeks of diet avoidance,acid production and anti-Helicobacter pylori treatment,and the ulcer did not improve.After 8 weeks of treatment with glucocorticoid on the basis of the original treatment,if the pathological Helicobacter pylori infection did not turn negative,continue to resist Helicobacter pylori infection for 2 weeks.Gastroscopy showed that 7 cases of ulcer were cured under gastroscope,of which 3 cases showed symptoms 4-8 weeks after withdrawal of hormone,and gastroscopy also showed duodenal bulb ulcer.2cases were re-treated with acid,gastric mucosa protection and glucocorticoid for 8weeks,the ulcer was cured,and then treated with low-dose corticosteroid(5-10mg),the condition was stable.Another case worried about hormone side effects was transferred to a specialist hospital in Shanghai for treatment.Half a year later,the gastroscope ulcer was cured after being given acid,protection of gastric mucosa and amino acid diet,the possibility of hormone dependent ulcer was considered,and 1case of ulcer was not improved,hormone resistance was considered.The other 4cases considered hormone sensitivity.Conclusion:1.The clinical features and gastroscopic manifestations of EG in children with peptic ulcer are not special.When they encounter peptic ulcer clinically,they should pay attention to food allergy in addition to HP infection.Pathological biopsy requires special staining to improve EoS count to determine whether it is EG;2.Whether the elevated EoS count in the peripheral blood cannot be used as a diagnostic criterion for EG,and other diseases that cause increased EoS in the gastrointestinal tract need to be excluded.To confirm the diagnosis,it is necessary to improve the endoscopy and biopsy pathology;3.The vast majority of children with EG manifested as peptic ulcer can be cured by treatment such as diet avoidance and acid production.Some need to be combined with hormone therapy.A few may have hormone dependence,and very few may have hormone resistance.