Eosinophilic Gastroenteritis: An Underdiagnosed Condition
Eosinophilic Gastroenteritis: An Underdiagnosed Condition
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DOI：
10.1007/s10620-016-4203-5
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发表时间：
2016-09-01
影响因子：
3.1
通讯作者：
Parasher, Gulshan
中科院分区：
文献类型：
--
作者：
Alhmoud, Tarik;Hanson, Joshua Anspach;Parasher, Gulshan
嗜酸性粒细胞性胃肠炎（EOGE）是一种罕见的特发性疾病，其特征是胃和/或肠的嗜酸性粒细胞占主导地位的炎症。我们的目的是确定流行病学，临床特征和结果的EOGE病例在三级医院。回顾性队列研究胃肠道嗜酸性粒细胞浸润患者从2004年至2014年。所有相关标本均由专家病理学家审查。显著的嗜酸性粒细胞浸润定义为胃或小肠中嗜酸性粒细胞/HPF> 25，结肠中嗜酸性粒细胞/HPF> 50。大多数（78%）成人病例为女性。临床表现是可变的;大多数患者（62%）有腹痛，其次是腹泻（31%）和恶心/呕吐（31%）。特应性和食物过敏分别出现在54%和38%的患者中。体重减轻和发育不良仅出现在儿科病例中（50 vs 0%; P = .01）。大多数EOGE病例（69%）有外周嗜酸性粒细胞增多，与无腹水患者相比，有腹水患者更突出（37.3 +/- 25.4 vs 9.3 +/-5.4%; P = 0.01）。在长期随访的患者中，30%的患者自发缓解，60%的患者对类固醇和/或限制饮食有反应，10%的患者患有难治性疾病。与嗜酸性粒细胞性食管炎相反，该疾病在成人中可能以女性为主。诊断需要高度的临床怀疑指数。关于限制饮食在成年患者中的长期结果和有效性还需要进一步研究。
Eosinophilic gastroenteritis (EOGE) is a rare idiopathic disease characterized by eosinophil-predominant inflammation of the stomach and/or intestines. Our aims are to determine the epidemiology, clinical features and outcomes of EOGE cases in a tertiary-care hospital.Retrospective cohort study of patients with gastrointestinal eosinophilic infiltration from 2004 through 2014. All relevant specimens were reviewed by an expert pathologist. Significant eosinophilic infiltrate was defined as > 25 eosinophils/HPF in the stomach or small intestine and > 50 eosinophils/HPF in the colon.Three hundred and sixty-one charts were reviewed and 13 EOGE cases were identified, including nine adults and four pediatric cases. The majority (78 %) of adult cases were females. Clinical presentation was variable; most patients (62 %) had abdominal pain, followed by diarrhea (31 %) and nausea/vomiting (31 %). Atopy and food allergies were present in 54 and 38 % of patients, respectively. Weight loss and failure to thrive were present only in pediatric cases (50 vs 0 %; P = .01). Most EOGE cases (69 %) had peripheral eosinophilia, which was more prominent in patients with ascites compared to patients without ascites (37.3 +/- 25.4 vs 9.3 +/- 5.4 %; P = .01). Among patients who had long-term follow-up; 30 % had spontaneous remission, 60 % responded to steroids and/or restriction diet, and 10 % had refractory disease.EOGE is an underdiagnosed condition. In contrast to eosinophilic esophagitis; the disease might be female-predominant in adults. High index of clinical suspicion is required for diagnosis. Further studies about the long-term outcomes and the efficacy of restriction diet in adult patients are required.