嗜酸细胞性胃肠炎的临床表现及病理学形态特征分析

嗜酸细胞性胃肠炎的临床表现及病理学形态特征分析,简介,嗜酸细胞性胃肠炎（EG）是一种少见胃肠道疾病。KLEIN 等人按嗜酸细胞浸润程度及部位提出该病分型，OYAIZU 等提出过敏机制。TALLEY 等人总结分析拟出嗜酸细胞性胃肠炎的诊断标准，现被广泛采用。,嗜酸细胞性胃肠炎36 例临床分析,研究一,研究目的,探讨嗜酸细胞性胃肠炎的临床特征及诊断方法。,研究方法,收集北京大学第三医院消化内科19952008年收治的嗜酸细胞性胃肠炎患者36例，对其一般情况、临床症状、实验室检查、消化道造影、内镜及病理表现和治疗随访等情况进行系统性回顾分析、总结。,研究结果,嗜酸细胞性胃肠炎多呈急性或亚急性病程,多有过敏性疾病病史或饮食的诱发因素。症状以腹痛、腹泻、恶心呕吐为主,无肠外症状。多数患者外周血嗜酸细胞计数升高。,研究结果,内镜下主要为炎性改变,活检部位以小肠特别是十二指肠检出率较高,病理示胃肠道组织以大量嗜酸细胞为主的炎性细胞浸润,其中统计小肠嗜酸细胞38/HP。治疗首选皮质激素,抗过敏、饮食调整有效。,结论,临床怀疑嗜酸细胞性胃肠炎时应在内镜或造影检查时行多部位活检，即使内镜和造影观察正常,也应进行黏膜活检，十二指肠是活检的关键部位，空肠活检亦能提高其诊断率。,蔡召强,王爱英,吕愈敏. 嗜酸细胞性胃肠炎36例临床分析J. 中国内镜杂志,2010,02:135-139.,Eosinophilicgastroenteritis:clinicalmanifestationsandmorphologicalcharacteristics, aretrospectivestudyof42 patients,Study Two,Introduction,Eosinophil associated gastrointestinal disorders (EGIDs), including eosinophilic esophagitis (EE) and eosinophilic gastroenteritis (EGE), are a spectrum of inflammatory diseases which are recognized with increasing frequency, characterized by eosinophilic infiltration of the gastrointestinal (GI) tract with varying GI symptoms.,Introduction,There are various clinical manifestations associated with this disease which range from conditions requiring surgery to remitting discomfort over long periods.Endoscopic and radiographic findings may vary from normal to slightly abnormal and cases may show diffuse abnormalities.,Introduction,In some cases, histological specimens are difficult to obtain, and as a result there are many instances of misdiagnosis or missed diagnosis of EGE in clinical practice.,OBJECTIVE,To evaluate theclinicalmanifestations, endoscopic, and radiologicalcharacteristics, histological features, and treatment ofeosinophilicgastroenteritisin adultpatients.,METHODS,Theclinicalrecords of 34patientsdiagnosed aseosinophilicgastroenteritisand eightpatientswho had abdominal symptoms and unexplained peripheral eosinophilia but no evidence of tissueeosinophilicinfiltration were reviewed and analyzed.,RESULTS,Thirteenpatientshad a history of asthma or allergic rhinitis, while 10 had an allergic history. Peripheral eosinophilia occurred in 83.3% ofpatients, IgE was elevated in half, and 2-macroglobulin was elevated in 92.8% ofpatients. The small intestine(82.4%)was the most common site involved.,RESULTS,Erythema was the predominate feature seen on endoscopy. Radiographicstudygenerally revealed thickening of the small intestinal wall. Eosinophilia generally involved the lamina propria of mucosa, but any layer of the gut could be affected, even in sites which had normal endoscopic or radiographic appearance.,RESULTS,In all, 15.4% (6/39) ofpatientshad Helicobacter pylori infection. Symptom remission within 1 week was found in 80% (20/25) ofpatientstreated with steroids and in 58.8% (10/17) ofpatientstreated with symptomatic treatment. In all, 85.7% (18/21) ofpatientshad their eosinophil counts return to normal within 2 weeks in the steroid treatment group, but none (0/13) in the other group.,CONCLUSION,Eosinophilicgastroenteritismay be more common than previously recognized. Multiple biopsies obtained from the both normal and abnormal appearing areas in the second part of the duodenum are highly recommended. Steroids are effective in relieving symptoms and improving eosinophilia.,Zhang L, Duan L, Ding S, Lu J, Jin Z, Cui R, McNutt M, Wang A. Eosinophilic gastroenteri