Idiopathic gastrointestinal eosinophilic infiltration syndrome

Introduction to idiopathic gastrointestinal eosinophilic infiltration syndrome Idiopathic Eosinophilic Infiltration Syndrome is a benign infiltrating disease of eosinophils originating in the gastrointestinal tract. It is characterized by gastrointestinal symptoms after eating certain foods. Signs, eosinophilia and other abnormal laboratory changes, corticosteroids have a good effect on the treatment of this disease. The cause has not been known so far, and it is considered to be an allergic disease. Due to the extensive infiltration of eosinophils in the diseased tissue, about 80% of patients have eosinophilia in the surrounding blood, and about 50% of patients have a history of personal or family allergies, so the disease may be internal or external. Sexual allergens caused by systemic or local allergic reactions, serum IgG, IgA increased, also indicated that there is immune response. After contact with a gastrointestinal sensitive tissue, a specific allergen reacts with antigens and antibodies in the gastrointestinal wall, releasing histamine-like vasoactive substances, causing gastrointestinal mucosal congestion, edema, eosinophil infiltration, and gastrointestinal smooth muscle. Increased secretion of sputum and mucus causes a series of gastrointestinal symptoms. basic knowledge The proportion of illness: 0.065% Susceptible people: no specific population Mode of infection: non-infectious Complications: upper gastrointestinal bleeding, diarrhea, pyloric obstruction, intestinal obstruction

Etiology of idiopathic gastrointestinal eosinophilic infiltration syndrome

The etiology has not been known so far, and it is considered to be an allergic disease. Due to the extensive infiltration of eosinophils in the diseased tissues, about 80% of patients have eosinophilia in the surrounding blood, and about 50% of patients have individuals or families. The history of allergies, so the disease may be caused by internal or external allergens, systemic or local allergic reactions, serum IgG, IgA increased, also indicated that there is immune response. After a certain allergen is in contact with gastrointestinal sensitive tissues, antigen and antibody reactions occur in the gastrointestinal wall, releasing histamine vasoactive substances, causing gastrointestinal mucosal congestion, edema, eosinophil infiltration, and gastrointestinal smooth muscle. Increased secretion of sputum and mucus causes a series of gastrointestinal symptoms.

Ureless classification:

Type I: extensive eosinophilic invasive gastritis (abbreviated as eosinophilic gastroenteritis), including Polyenteric, Monoenteric, and Regional.

Type II: localized eosinophilic invasive granuloma (referred to as eosinophilic granuloma), including regional, polypoid.

The disease can be extensively involved in the gastrointestinal tract, from the pharynx to the rectum. Among them, the stomach and small intestine are most common, and the liver and the omentum can be invaded. A large amount of eosinophil infiltration can be seen under the microscope, which can be piled up. May be involved in the mucosa and submucosa, but also a layer of involvement, the most common is the mucosa and submucosa, followed by the muscle layer, the serosa layer is the least seen.

Type I (eosinophilic gastroenteritis): a characteristic type of gastroenteritis, fiber gastroscopy, diffuse type of mucosal congestion, edema, thickening, occasionally superficial ulcer erosion, stomach lesions resemble general superficial gastritis, Biopsy confirmed a large number of eosinophilic infiltration, intestinal lesions are mostly diffuse, affected intestinal wall edema, thickening, serosal surface tarnish, covered with cellulose exudate, single intestinal table is mostly stomach or small intestine A certain organ lesion, localized lesions, localized in the stomach, lesions often in the stomach pylorus or antrum, multiple intestinal, stomach, duodenum, small intestine, etc. have lesions, often extensive Sexual, non-continuous lesions.

Kleim divides lesions into three types based on the degree of eosinophil infiltration:

1. Prominent mucosal lesions: mainly mucosal infiltration, mucosal edema, ulcers, and blood loss, iron deficiency, malabsorption and low protein.

2. Prominence of myometrial lesions: mainly myometrial invasion, nodular thickening of the gastrointestinal wall, and bulging into the gastrointestinal tract, leading to stenosis or obstruction of the pylorus or intestine, clinically required to type II ( Identification of eosinophilic granuloma.

3. Serosal lesions prominent: mainly serosal infiltration, thickening of the serosa, edema, often involving mesenteric lymph nodes, and more eosinophilic (or eosinophils) ascites.

Type II (eosinophilic granuloma):

This type is rare. Single or multiple tumors can be formed under the mucosa, often with pyloric obstruction. The stomach (stomach sinus) is the most common. And spread to the surrounding growth, invading the ileum, colon. It is a solid or rubbery polypoid mass, pedunculated or pedicled into the cavity, with a smooth surface and mucous membrane coverage. Eosinophilic granulation is most common in the stomach (53%), followed by the colon, rectum (28%), and small intestine (16%).

Idiopathic gastrointestinal eosinophilic infiltration syndrome prevention

Take care to avoid eating allergic foods or drugs.

Idiopathic gastrointestinal eosinophilic infiltration syndrome complications Complications upper gastrointestinal bleeding diarrhea pyloric obstruction intestinal obstruction

Easy complicated with upper gastrointestinal bleeding, diarrhea, pyloric obstruction, intestinal obstruction and other diseases.

Idiopathic gastrointestinal eosinophilic infiltration syndrome symptoms Common symptoms Nausea eosinophilia Ascites abdominal pain Diarrhea Weight loss Upper gastrointestinal bleeding Gastrointestinal symptoms

The disease is often caused by abdominal pain, nausea, vomiting, symptoms vary according to the location of the lesion, mostly chronic, often characterized by periodic attacks and spontaneous relief.

Type I: more common in 30 to 50 years old, 80% have gastrointestinal symptoms, half of patients may have other allergic diseases, such as allergic rhinitis, asthma, etc. This type mainly has upper abdominal pain, nausea, vomiting, diarrhea Such symptoms, irregular onset, can be related to certain foods, severe mucosal involvement can cause upper gastrointestinal bleeding, diarrhea, malabsorption, intestinal protein loss, iron deficiency, weight loss, etc., muscle layer involvement can cause pyloric Obstruction or intestinal obstruction, and the corresponding symptoms and signs, sometimes misdiagnosed as Crohn's disease or tumor serosa involvement may have ascites containing a large number of eosinophils (called eosinophilic ascites) or pleural effusion, ascites is generally exudate Sex.

Type II is more common in 40 to 60 years old. This type has a long history of stomach disease, and the onset is more urgent. It may have upper abdominal pain and nausea, vomiting, and more common with peptic ulcer (mostly huge ulcers). For polypoid type, upper gastrointestinal bleeding may be the only symptom. The lesion may be close to the pylorus and may cause pyloric obstruction. When the lesion is in the intestine, the intestine may be formed due to the formation of the tumor, thickening of the intestinal wall, and edema leading to dysfunction. Stack or intestinal obstruction, occurred in the ileum, rapid onset, may be misdiagnosed as acute appendicitis due to right lower quadrant pain, tenderness, rebound tenderness or local muscle tension.

Examination of idiopathic gastrointestinal eosinophilic infiltration syndrome

Laboratory examination

In most patients, peripheral blood eosinophilia increased, and the absolute count of eosinophils in patients with mucosal lesions and myometrial lesions averaged (1 to 2) × 10 ⁹ /L, mainly in serosal lesions. At an average of 8 × 10 ⁹ /L, often accompanied by iron deficiency anemia, fecal occult blood more positive, a large number of Charcot-Leyden crystals, and increased ESR, decreased plasma albumin, increased blood IgE, IgG.

2. X-ray inspection

Type I: X-ray barium meal examination is about 40% normal, can also show esophagus, antrum or small intestine stenosis, mucosal folds widened, peristalsis disappeared, pyloric obstruction, intestinal wall thickening, nodular filling defect and other lesions, sometimes Also visible in the stomach, small intestine expansion.

Type II: It can be found that the mucous membrane of the antrum is irregular, sometimes nodular or polypoid, the stomach wall is thickened, stiff, gastrointestinal stenosis, similar to the changes of new organisms, and also shows changes in gastrointestinal filling defects.

3. Endoscopy

Type I: Endoscopic examination revealed mucosal folds, congestion, edema, erosion, hemorrhage or visible proliferative area. There is a large amount of eosinophil infiltration in this biopsy, which has diagnostic value for this disease.

Type II: endoscopic examination showed mucosal congestion, edema, polypoid mass, often mistaken for tumors, Crohn's disease, etc.

Diagnosis and differentiation of idiopathic gastrointestinal eosinophilic infiltration syndrome

diagnosis

According to Leinbach's diagnostic criteria are:

1 peripheral blood eosinophilia.

2 After eating, it causes gastrointestinal symptoms and signs.

3 histology confirmed that the gastrointestinal tract has eosinophilia or infiltration, in view of the lack of specificity of the gastrointestinal manifestations of this disease, it should pay attention to the history of previous allergies, peripheral blood (ascites or biopsy) eosinophilia In combination with gastrointestinal X-ray barium meal, fiber endoscopy for diagnosis, for early diagnosis, there are unexplained gastrointestinal symptoms, especially individuals with a history of allergic diseases in the family or eating certain foods, intake of certain After the drug appears or aggravates gastrointestinal symptoms and signs, peripheral blood eosinophilia, should consider the possibility of this disease, blood, ascites, eosinophilia, fiberoptic endoscopy, marked hyperemia, edema, biopsy It was found that many specimens had more eosinophilic infiltration or fasting suspicious foods. When treatment with glucocorticoids can relieve symptoms, consider the diagnosis of eosinophilic ascites or eosinophilic gastroenteritis.

Differential diagnosis

Secondary peripheral blood eosinophilia

There are many causes of eosinophilia in the surrounding blood, such as allergies, parasitic infections, chemical factors, Hodgkin's disease, cystic rupture of cysticercosis, etc., but each has its own special performance, refer to certain laboratory tests. Can be diagnosed.

2.Crohn's disease

The disease may have nausea, vomiting, abdominal pain, diarrhea, especially when the X-ray shows mucosal edema, thickening of the intestinal wall is ileocolitis, should be identified with Crohn's disease, peripheral blood eosinophilia suggests eosinophilic stomach Enteritis; fistula in the intestine, presence of stenosis or secondary manifestations of intestinal inflammatory disease (stomatitis, arthritis, etc.) suggest Crohn1 disease.

3. High eosinophilic syndrome

High eosinophilic syndrome, in addition to increased eosinophils in the peripheral blood, is also associated with multiple system involvement, such as heart, brain, kidney, lung and skin, can also affect the gastrointestinal tract, a wide gastrointestinal tract Eosinophil infiltration, the disease course is short, the prognosis is poor, therefore, if there is obvious clinical manifestations of organ involvement outside the gastrointestinal tract, this syndrome should be considered.

4. Gastrointestinal malignancy, malignant lymphoma

When eosinophilic granuloma occurs in the stomach, it must be differentiated from gastric cancer and gastric malignant lymphoma.

The disease eosinophilic granuloma type, liver, spleen, lymph node enlargement must be distinguished from tissue basophilic leukemia, the latter also known as mast cell leukemia, relatively rare, mast cell malignant proliferative disease, clinical manifestations There are 3 stages:

1 pigmented urticaria.

2 systemic tissue basophilia.

3 tissue basophilic leukemia, the course of disease can be as long as several years, once in the third stage, the survival is only 9 months, the diagnosis depends on the biopsy, skin, liver, spleen, lymph node tissue basophil infiltration or surrounding A large number of tissue basophils were found in blood and bone marrow.

In addition, eosinophilic granuloma must also be differentiated from eosinophilic lymphogranuloma, which has an increase in eosinophils in the blood, and even mild infiltration of eosinophils in the affected skin and subcutaneous tissue. Acidic cell proliferative lymphogranuloma, often accompanied by local or systemic superficial lymph node rubbery swelling; often dry skin, pigmentation, peeling, atrophy and other diseases; blood in addition to eosinophilia, there is a relative lymphocyte increase The lesion is characterized by a large number of eosinophils, lymphocyte hyperplasia and mononuclear cell infiltration; sensitive to deep X-ray radiation therapy.

Because the disease can cause digestive tract obstruction, any gastrointestinal disease caused by obstruction should consider the possibility of the disease.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.