Eosinophilic gastroenteritis

Introduction to eosinophilic gastroenteritis Eosinophilic gastroenteritis (EG) is a rare disease. This disease usually involves the antrum and proximal jejunum. If the colon is involved, the cecum and ascending colon are more common. According to the infiltration range, it can be divided into limited type and diffuse type. Western medicine treatment principle is to remove allergens, inhibit allergic reactions and stabilize mast cells, to relieve symptoms and remove lesions. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: upper gastrointestinal bleeding, diarrhea, pyloric obstruction, intestinal obstruction

Eosinophilic gastroenteritis

The cause of the disease is unclear. A small number of patients have a family history of asthma, food allergies or allergic diseases, but most patients do not have an allergic history. Endoscopy showed that eosinophils infiltrate in the gastrointestinal tract, from the pharynx to the rectum, with the stomach and small intestine being the most common.

Eosinophilic gastroenteritis prevention

Take care to avoid eating allergic foods or drugs.

Eosinophilic gastroenteritis complications Complications upper gastrointestinal bleeding diarrhea pyloric obstruction intestinal obstruction

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

Eosinophilic gastrointestinal symptoms Common symptoms Lower abdominal pain Abdominal pain Diarrhea Thoracic water Stress Ascites Gastrointestinal symptoms Eosinophilia Upper gastrointestinal hemorrhage Edema

The disease lacks clinical specific performance and is a self-limiting allergic disease. Although it can be repeated repeatedly, the prognosis is good. According to the infiltration range, it can be divided into localized and diffuse.

(1) Diffuse type: more common in 30-50 years old, slightly more men than women. The course of the disease can last for decades. 80% of patients have gastrointestinal symptoms, mainly manifested as upper abdominal spastic pain, with malignant, vomiting, fever, no obvious regularity, may be related to certain foods, can not be relieved with acid-resistant antispasmodic agents, but can be self-reliant ease.

1, eosinophilic gastroenteritis infiltration of the mucosa-based people with upper gastrointestinal bleeding, diarrhea, malabsorption, intestinal protein loss, hypoproteinemia, iron deficiency anemia and weight loss. About 50% of patients have asthma or allergic rhinitis, eczema or urticaria. The fecal occult blood test is positive, and there may be crystallization of Charcot. Peripheral blood eosinophils increased in 80% of patients. Serum protein was reduced and the D-xylose tolerance test was abnormal. X-ray gastrointestinal barium meal examination was normal or showed signs of mucosal edema. Endoscopic examination showed mucosal congestion, edema or erosion. Biopsy has eosinophil infiltration.

2. The infiltration of eosinophilic gastroenteritis mainly causes thickening and stiffness of the stomach and small intestine wall. Patients often have symptoms and signs of pyloric obstruction or incomplete intestinal obstruction. X-ray gastrointestinal barium examination showed pyloric stenosis, decreased peristalsis or multiple polypoid filling defects in the antrum. Diagnosis By gastric and small intestine biopsy, extensively mature eosinophilic granulocytes are infiltrated into the mucosa and extend through the muscular layer to the serosa layer.

3, eosinophilic gastroenteritis infiltration in the subserosal layer of the main can often occur ascites or pleural effusion, which contains a large number of eosinophils. Laparoscopic exploration of common small intestine serosa thickening and eosinophil infiltration. Similar changes were seen in gastric serosal lesions.

(2) The limitation type is more common in 40 to 60 years old, and there is no significant difference in the incidence rate between men and women. The main symptoms are upper abdominal pain, nausea, vomiting, acute onset, and shorter duration. The patient's allergic history was not obvious, and only a few of the peripheral blood showed an increase in eosinophils. X-ray gastrointestinal barium meal angiography can show thickening of the antrum, stiffness, sinus stenosis, smooth round or oval and lobulated filling defects, similar to tumors. Endoscopic examination showed a polypoid mass, mucosal congestion, edema, and was easily misdiagnosed as a tumor or a Crohn's disease. A small amount of eosinophil infiltration was seen in the tissue examination.

Examination of eosinophilic gastroenteritis

(1) Laboratory inspection

1, blood test, 80% of patients with peripheral blood eosinophilia, mucosal and submucosal lesions laboratory examination and myometrial lesions mainly patients (1 ~ 2) × 109 / L, plasma cell disease-based , up to 8 × 109 / L. There may also be iron deficiency anemia, serum albumin decreased, blood IgE increased, and erythrocyte sedimentation rate increased.

2, stool examination, acid cell gastroenteritis stool examination is the meaning of exclusion of intestinal parasite infection, and some can be seen Charco-Leyden (Charcot-Leyden) crystal, routine examination of occult blood is positive, some patients have light Moderate steatorrhea. Cr-labeled albumin increased, -antitrypsin clearance increased, and D-xylose absorption test was abnormal.

(2) Other auxiliary inspections

1, X-ray examination, eosinophilic gastroenteritis lack of specificity, X-ray barium meal can be seen mucosal edema, wrinkle widening, nodular filling defect, gastrointestinal wall thickening, stenosis and obstruction.

2, CT examination, you can find thickening of the gastrointestinal wall, mesenteric lymphadenopathy or ascites.

3, endoscopy and biopsy, for mucosal and submucosal lesions dominated by eosinophilic gastroenteritis. Microscopic mucosal folds, congestion, edema, ulcers or nodules can be seen under the microscope. Biopsy confirmed a large number of eosinophil infiltration from pathological findings, which is valuable for diagnosis. However, biopsy tissue is of little value to patients with predominant muscle and serosal involvement, and sometimes needs to be confirmed by surgery and pathology.

4, abdominal puncture, ascites patients must be diagnosed abdominal puncture, ascites exudative, containing a large number of eosinophils, must be stained with ascites smear to distinguish eosinophils and neutrophils.

5, laparoscopy, laparoscopic lack of specific performance, lighter only peritoneal congestion, severe cases can be similar to peritoneal metastases. The significance of laparoscopy is to perform biopsy of abdominal mucosa and obtain pathological diagnosis.

6, surgical exploration, for suspected eosinophilic gastroenteritis is generally not confirmed by laparotomy, but when there is intestinal obstruction or pyloric obstruction or suspected tumor surgery.

Diagnosis and identification of eosinophilic gastroenteritis

1, indigestion, patients with eosinophilic gastroenteritis may have abdominal pain, nausea, vomiting, abdominal distension and other symptoms of digestive reflux esophagitis, but often lack specificity, for patients with dyspepsia Identification of peptic ulcer, reflux esophagitis, gastric cancer, chronic pancreatitis.

2, intestinal obstruction, muscle layer type can often occur intestinal obstruction, should pay attention to the exception of gastrointestinal tumors and intestinal vascular diseases.

3, ascites, more common in serosal eosinophilic gastroenteritis. Ascites routine and biochemical tests, ascites CEA test, ascites pathological examination is helpful for the diagnosis of the disease.

4, eosinophilia, is a systemic disease of unknown etiology, it can also affect the gastrointestinal tract. 60% of the liver, 14% of the gastrointestinal tract, diffuse eosinophilic gastroenteritis, in addition to the gastrointestinal tract, often 50% involving the organs outside the gastrointestinal tract.

5, intestinal parasite infection, can cause a variety of non-specific gastrointestinal system symptoms, as well as peripheral blood eosinophilia. Repeated examination of fecal eggs can be identified.

6, allergic diseases, bronchial asthma, allergic rhinitis, urticaria, in addition to peripheral blood eosinophils, each has its clinical manifestations.

7, eosinophilic granuloma, mainly in the stomach, large and small intestine, is a localized mass, peripheral blood eosinophils generally do not rise, pathological features of eosinophilic granuloma mixed in the connective tissue matrix.

8, rheumatic diseases, various vasculitis, such as allergic granulomatosis (Churg-Strauss syndrome) and nodular polyarteritis, other connective tissue diseases such as scleroderma, dermatomyositis and polymyositis Can affect the gastrointestinal tract, abdominal pain, indigestion and other symptoms, there may be varying degrees of peripheral blood eosinophilia. Small intestinal mucosal biopsy can help with differential diagnosis.

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