混合型嗜酸性粒细胞性胃肠炎伴腹水1例并文献复习
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摘要
目的探讨嗜酸性粒细胞性胃肠炎的临床特点、内镜下表现及诊断、治疗经验,以提高临床上对该病的认识。方法收集本院收治的1例嗜酸性粒细胞性胃肠炎伴腹水的患者的临床资料,结合文献复习,探讨嗜酸性粒细胞性胃肠炎患者的临床表现、实验室检查和内镜表现的特点。结果患者女,23岁,以"呕吐、腹痛、腹泻、腹胀"为主要表现,入院检查外周血嗜酸性粒细胞、血清总IgE、骨髓中嗜酸性粒细胞及腹水中嗜酸性粒细胞明显升高,胃、肠镜检查提示胃肠道黏膜充血、糜烂、炎性改变,肠镜下病变黏膜活检病理示:升结肠慢性炎症、嗜酸性粒细胞浸润,患者最终诊断为嗜酸性粒细胞性胃肠炎,经口服甲泼尼龙、抗过敏、腹腔穿刺置管引流腹水等治疗2周后症状缓解,复查外周血嗜酸性粒细胞降至正常,复查腹部B超未见腹腔积液,故好转出院,出院后随访。结论嗜酸性粒细胞性胃肠炎患者临床表现、实验室检查和内镜表现多样,缺乏特异性,外周血嗜酸性粒细胞、血清总IgE、骨髓中嗜酸性粒细胞及腹水中嗜酸性粒细胞升高对本病有提示意义,确诊需组织病理学结果,大部分患者经糖皮质激素治疗预后较好。
Objective To investigate the clinical features, endoscopic manifestations, diagnosis and treatment of eosinophilic gastroenteritis(EGE) in order to improve clinical understanding of the disease. Methods The clinical data of a case of eosinophilic gastroenteritis with ascites in our hospital were collected. The clinical manifestations, laboratory examinations and endoscopic findings of eosinophilic gastroenteritis were studied with literature review. Results A 23-year-old woman presented with vomiting, abdominal pain, diarrhea and abdominal distention. The eosinophils in peripheral blood, total IgE in serum, eosinophils in bone marrow and eosinophils in ascites were significantly elevated. Gastroenteroscopy and enteroscopy revealed gastrointestinal mucosal hyperemia, erosion and inflammatory changes. Pathological examination showed chronic inflammation and eosinophilic infiltration of ascending colon. The patient was finally diagnosed as eosinophilic gastroenteritis. Symptoms were relieved after 2 weeks of oral administration of methylprednisolone, anti-allergic therapy, abdominal puncture and drainage of ascites. The eosinophilic granulocytes in peripheral blood were returned to normal after re-examination, and abdominal ultrasonography did not see ascites.Then the patient was discharged and followed up after discharge. Conclusion The clinical, laboratory and endoscopic manifestations of patients with eosinophilic gastroenteritis are various and lack specificity. The elevation of eosinophils in peripheral blood, serum total IgE, bone marrow eosinophils and ascites eosinophils may be helpful to the diagnosis of Eosinophilic gastroenteritis, but histopathological findings are needed for the final diagnosis. Glucocorticoid treatment has a better prognosis.
Objective To investigate the clinical features, endoscopic manifestations, diagnosis and treatment of eosinophilic gastroenteritis(EGE) in order to improve clinical understanding of the disease. Methods The clinical data of a case of eosinophilic gastroenteritis with ascites in our hospital were collected. The clinical manifestations, laboratory examinations and endoscopic findings of eosinophilic gastroenteritis were studied with literature review. Results A 23-year-old woman presented with vomiting, abdominal pain, diarrhea and abdominal distention. The eosinophils in peripheral blood, total IgE in serum, eosinophils in bone marrow and eosinophils in ascites were significantly elevated. Gastroenteroscopy and enteroscopy revealed gastrointestinal mucosal hyperemia, erosion and inflammatory changes. Pathological examination showed chronic inflammation and eosinophilic infiltration of ascending colon. The patient was finally diagnosed as eosinophilic gastroenteritis. Symptoms were relieved after 2 weeks of oral administration of methylprednisolone, anti-allergic therapy, abdominal puncture and drainage of ascites. The eosinophilic granulocytes in peripheral blood were returned to normal after re-examination, and abdominal ultrasonography did not see ascites.Then the patient was discharged and followed up after discharge. Conclusion The clinical, laboratory and endoscopic manifestations of patients with eosinophilic gastroenteritis are various and lack specificity. The elevation of eosinophils in peripheral blood, serum total IgE, bone marrow eosinophils and ascites eosinophils may be helpful to the diagnosis of Eosinophilic gastroenteritis, but histopathological findings are needed for the final diagnosis. Glucocorticoid treatment has a better prognosis.
引文
[1]郭锐芳,李宏亮,胡燕梅,等.嗜酸性粒细胞性胃肠炎254例分析[J].宁夏医科大学学报,2016,38(7):819-821.
[2] Wong GW, Lim KH, Wan WK, et al. Eosinophilic gastroenteritis:Clinical profiles and treatment outcomes, a retrospective study of 18 adult patients in a Singapore Tertiary Hospital[J]. Medical Journal of Malaysia, 2015,70(4):232-237.
[3] Leal R, Fayad L, Vieira D, et al. Unusual presentations of eosinophilic gastroenteritis:Two case reports[J]. The Turkish Journal of Gastroenterology,2014,25(3):323-329.
[4] Reed C, Woosley JT, Dellon ES. Clinical characteristics, treatment outcomes, and resource utilization in children and adults with eosinophilic gastroenteritis[J]. Digestive and Liver Disease, 2015,47(3):197-201.
[5]王艳丽,程艳波,杜远举.儿童嗜酸粒细胞性胃肠炎36例临床特征及治疗分析[J].中国全科医学,2016,19(15):1803-1808.
[6] Jo YM, Jang JS, Han SH, et al. Eosinophilic Gastritis Presenting as Tissue Necrosis[J]. Clicical Endoscopy, 2015,6(48):558-562.
[7] Ridolo E, Melli V, De'Angelis G, et al. Eosinophilic disorders of the gastro-intestinal tract:an update[J]. Clinical and Molecular Allergy, 2016, 17(14):1-11.
[8] Talley NJ, Shorter RG, Phillips SF, et al. Eosinophilic gastroenteritis:a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues[J]. Gut, 1990, 31(1):54-58.
[9]杨韵宏.39例嗜酸细胞性胃肠炎门诊患者临床资料分析[J].中国校医,2016,30(6):467-468.
[10] Anshi Shukla AMSU. Elements involved In Promoting Eosinophilic Gastrointestinal Disorders[J]. J Genet Syndr Gene Ther, 2015,2(6):1-22.
[11] Uppal V, Kreiger P, Kutsch E. Eosinophilic Gastroenteritis and Colitis:a Comprehensive Review[J].Clinical Reviews in Allergy&Immunology, 2016, 50(2):175.
[12] Lucendo AJ, Arias A. Eosinophilic gastroenteritis:an update[J]. Expert Rev Gastroenterol Hepatol,2012,6(5):591-601.
[13] Pinetond CG, Gonzalez F, Canva JY, et al. Natural history of eosinophilic gastroenteritis[J]. Clin Gastroenterol Hepatol, 2011,9(11):950-956.
[2] Wong GW, Lim KH, Wan WK, et al. Eosinophilic gastroenteritis:Clinical profiles and treatment outcomes, a retrospective study of 18 adult patients in a Singapore Tertiary Hospital[J]. Medical Journal of Malaysia, 2015,70(4):232-237.
[3] Leal R, Fayad L, Vieira D, et al. Unusual presentations of eosinophilic gastroenteritis:Two case reports[J]. The Turkish Journal of Gastroenterology,2014,25(3):323-329.
[4] Reed C, Woosley JT, Dellon ES. Clinical characteristics, treatment outcomes, and resource utilization in children and adults with eosinophilic gastroenteritis[J]. Digestive and Liver Disease, 2015,47(3):197-201.
[5]王艳丽,程艳波,杜远举.儿童嗜酸粒细胞性胃肠炎36例临床特征及治疗分析[J].中国全科医学,2016,19(15):1803-1808.
[6] Jo YM, Jang JS, Han SH, et al. Eosinophilic Gastritis Presenting as Tissue Necrosis[J]. Clicical Endoscopy, 2015,6(48):558-562.
[7] Ridolo E, Melli V, De'Angelis G, et al. Eosinophilic disorders of the gastro-intestinal tract:an update[J]. Clinical and Molecular Allergy, 2016, 17(14):1-11.
[8] Talley NJ, Shorter RG, Phillips SF, et al. Eosinophilic gastroenteritis:a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues[J]. Gut, 1990, 31(1):54-58.
[9]杨韵宏.39例嗜酸细胞性胃肠炎门诊患者临床资料分析[J].中国校医,2016,30(6):467-468.
[10] Anshi Shukla AMSU. Elements involved In Promoting Eosinophilic Gastrointestinal Disorders[J]. J Genet Syndr Gene Ther, 2015,2(6):1-22.
[11] Uppal V, Kreiger P, Kutsch E. Eosinophilic Gastroenteritis and Colitis:a Comprehensive Review[J].Clinical Reviews in Allergy&Immunology, 2016, 50(2):175.
[12] Lucendo AJ, Arias A. Eosinophilic gastroenteritis:an update[J]. Expert Rev Gastroenterol Hepatol,2012,6(5):591-601.
[13] Pinetond CG, Gonzalez F, Canva JY, et al. Natural history of eosinophilic gastroenteritis[J]. Clin Gastroenterol Hepatol, 2011,9(11):950-956.