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1、嗜酸细胞性胃肠炎:临床表现和形态特征-一项基于42例患者的回顾性研究,简介,嗜酸性粒细胞相关的胃肠道疾病(EGIDs),包括嗜酸性粒细胞性食管炎(EE)和嗜酸性粒细胞性胃肠炎(EGE)，是一组炎性疾病，正越来越收到重视，以胃肠道嗜酸性粒细胞浸润以及伴有不同程度的胃肠道症状为特征。,简介,本病有各种各样的临床表现：从需要手术治疗的情况到长期反复腹部不适。内镜和影像学结果可能会正常或略有异常，部分病例可能会呈现弥漫性异常。在某些情况下,很难获得组织学标本,因此在临床实践中，误诊或漏诊的情况很多。,研究目的,评估嗜酸细胞性胃肠炎在成人患者中的临床表现、内镜和影响学特征、组织学特性,和治疗。,研究方法
2、,本研究回顾和分析了明确诊断为嗜酸性胃肠炎的34位患者和有腹部症状和原因不明的外周嗜酸性粒细胞增多，但没有证据表明嗜酸性粒细胞组织渗浸润的8位患者的临床记录。,研究结果,13名患者有哮喘或过敏性鼻炎,而10名患者有过敏史。外周嗜酸性粒细胞增多发生在83.3%的患者，IgE升高发生在50%的患者,2-巨球蛋白升高发生在92.8%的病人。病变最长累及小肠(82.4%)。红斑是最常见的内镜下特征。影像学检查通常显示小肠壁的增厚。,研究结果,嗜酸性粒细胞增多通常累及粘膜固有层,但胃肠道各层都可能会受到影响,甚至可以发生在内镜或影像学外观正常的部位。总之,15.4%(6/39)的患者有幽门螺杆菌感染。有
3、80%(20/25)的患者在应用类固醇激素治疗一周内症状缓解，58.8%(10/17)的患者给予对症治疗一周内症状缓解。,研究结果,在类固醇激素治疗组,有85.7%(18/21)的患者在2周内嗜酸性粒细胞计数恢复正常,但在另一组没有没有1例(0/13)嗜酸性粒细胞计数2周内恢复正常。,结论,嗜酸细胞性胃肠炎可能比以前认为的更常见。于十二指肠降段外观正常和异常的部位多次活组织检查是高度推荐的。类固醇激素治疗可以有效缓解症状和改善嗜酸性粒细胞增多。,Eosinophilicgastroenteritis:clinicalmanifestationsandmorphologicalcharacter
4、istics,aretrospectivestudyof42 patients,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 eosinophili
5、c 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 nor
6、mal 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,endos
7、copic,and radiologicalcharacteristics,histological features,and treatment ofeosinophilicgastroenteritisin adultpatients.,METHODS,Theclinicalrecords of 34patientsdiagnosed aseosinophilicgastroenteritisand eightpatientswho had abdominal symptoms and unexplained peripheral eosinophilia but no evidence
8、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 sma
9、ll 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,eve
10、n 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%
11、(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 are
12、as 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 gastroenteritis:clinical manifestations and morphologicalcharacteristics,a retrospective study of 42 patients.Scand J Gastroenterol.2011 Sep;46(9):1074-80.,Thanks for your attention!,
