儿童嗜酸细胞性胃肠炎2例分析并文献复习

目的探讨儿童嗜酸细胞性胃肠炎的临床病理特点、治疗及预后。方法回顾性分析2例儿童嗜酸细胞性胃肠炎的临床表现、实验室检查、内镜病理结果、治疗经过及预后,并结合文献复习进行分析。结果 2例患儿发病年龄分别为13岁、14岁,例1为男性患儿,以急性胰腺炎起病,例2为女性患儿,有食物过敏史,以不明原因腹水起病;2例患儿外周血嗜酸性粒细胞比例均显著升高(45.9%~64.8%),血清IgE均明显升高(246~393 IU/ml);2例患儿的骨髓细胞学检查均提示嗜酸性粒细胞比例增加;例1行胃镜、例2行胃镜和肠镜,内镜检查均提示胃肠道黏膜慢性炎症,例1病理活检提示十二指肠黏膜嗜酸性粒细胞浸润,例2病理活检提示胃肠道多处黏膜嗜酸性粒细胞浸润。2例患儿经食物回避、激素抗炎及抗过敏等综合治疗1周左右病情均明显缓解,复查血常规嗜酸性粒细胞均降至正常,例1随访24个月,例2随访2个月,病情均未见反复。结论儿童嗜酸细胞性胃肠炎临床表现及内镜所见缺乏特异性,不明原因的胃肠道症状伴外周血、骨髓嗜酸性粒细胞比例升高时应考虑到该病可能,腹水及内镜黏膜活检见嗜酸性粒细胞浸润,排除其他可能的疾病则可明确诊断。     

嗜酸细胞性胃肠道疾病的发病机制研究进展

嗜酸细胞性胃肠道疾病是指反复或持续存在胃肠道症状, 伴有消化道黏膜内嗜酸性粒细胞病理性升高的一组疾病。病理学特征性表现为胃肠道黏膜内嗜酸性粒细胞数量增多, 嗜酸细胞性食管炎患者食道黏膜固有层可见纤维化。趋化嗜酸性粒细胞聚集的细胞因子有多种, 包括Th2细胞因子、嗜酸细胞趋化因子、胸腺基质淋巴细胞生成素、巨噬细胞移动抑制因子、唾液酸结合免疫球蛋白样凝集素、整合素和细胞外基质蛋白。嗜酸细胞性胃肠道疾病的肠道组织损伤可能与嗜酸性粒细胞脱颗粒分泌特异性产物、炎症反应及氧化损伤、纤维化和组织重塑以及屏障功能受损有关。     

嗜酸细胞性胃肠炎11例

目的分析小儿嗜酸细胞性胃肠炎(EG)的临床特点、诊断要点、治疗预后和误诊原因。方法本院2006-2008年收治EG患儿11例,对其病史、临床特点、实验室检查、内镜表现和治疗、随访情况进行回顾性分析,应用SPSS10.0软件进行统计学分析。结果1.EG患儿的临床表现多样,包括腹痛(5例)、腹泻(7例)、便血(5例)、低热(2例)等。2.EG患儿中54.55%的过敏体质与EG发病密切相关。3.所有患儿中,18.18%外周血中嗜酸性粒细胞(EOS)计数增高明显,可随症状缓解而下降。4.患儿内镜表现均无明显特异性,可见到黏膜片状糜烂、浅溃疡、散在充血斑或出血点,以胃窦、十二指肠、回肠末端、回盲部最明显,活检可见大量EOS浸润。5.影像学检查无特异性,10例(90.91%)黏膜型CT或消化道钡餐检查无特殊发现,1例(9.09%)肌型肠壁肌层受累时见不全梗阻。6.激素为治疗EG的一线药物,可迅速缓解症状,并使EOS恢复正常。7.本病是一种自限性变应性疾病,虽可反复发作,但长期随访未见恶变,多数预后良好。结论EG的临床表现和内镜表现均无特异性,胃肠黏膜组织中EOS增多是诊断的关键。本病极易造成误诊,明确诊断需依靠活组织病理...     

嗜酸细胞性胃肠炎合并急性胰腺炎1例并文献复习

目的 提高对儿童嗜酸细胞性胃肠炎（EG）的认识。方法 报告1例EG合并急性胰腺炎患儿的诊断和治疗过程,系统检索文献并汇总复习类似病例相关报道,分析总结EG合并急性胰腺炎的临床特征。结果 男,14岁,以“反复腹痛、腹泻1周”主诉入院。初步诊断为急性胰腺炎,入院后查血嗜酸性粒细胞（EOS）0.62,血清IgE 393 U·mL-1,骨髓细胞学检查示EOS比例增加,内镜下显示胃肠道黏膜慢性炎症,病理活检显示十二指肠黏膜EOS浸润,诊断为EG。经泼尼松抗炎和抗过敏药物等治疗1周后病情缓解,血EOS降至正常,随访2年患儿病情稳定无反复。在万方、中国知网、EMBASE和PubMed等数据库系统检索相关文献11篇,汇总EG合并急性胰腺炎14例（儿童病例4例）,均以急性胰腺炎表现起病而误诊,以腹痛、恶心和呕吐等非特异性临床表现为主,外周血EOS均明显升高,腹腔积液EOS比例对诊断EG合并急性胰腺炎有重要提示意义,14例均有不同程度的胃、十二指肠黏膜异常改变。13例明确诊断后接受糖皮质激素治疗预后良好;1例手术切除胰腺后复发,诊断EG后予糖皮质激素治疗缓解。结论 EG合并急性胰腺炎罕见,对不明原因急性胰腺炎,且伴血EOS增多或常规抑酶抑酸治疗后临床转归差者,应警惕EG可能,完善内镜病理活检可以明确诊断。     

以大量腹水为首发表现的嗜酸细胞性胃肠炎6例

目的 探讨以大量腹水为首发症状的儿童嗜酸细胞性胃肠炎(EG)的临床表现及胃镜特征,为临床早期诊断和治疗该病积累经验.方法 对南京医科大学附属南京儿童医院2009年5月至2012年12月收治的6例EG患儿的临床特点、实验室检查、胃镜表现和治疗情况进行分析.结果 6例患儿均为EG浆膜病变型,主要临床表现为腹胀、腹水;外周血嗜酸性粒细胞(EOS)计数明显增多(5.1×109/L ～20.6×109/L),患儿腹水中均见大量EOS;内镜下表现为6例均有胃黏膜充血水肿,其中2例胃窦黏膜散在糜烂,1例食管下段黏膜粗糙水肿,3例十二指肠黏膜充血水肿,1例十二指肠球部结节样增生,6例黏膜病理检查均可见EOS增多;予回避可疑食物,口服糖皮质激素治疗1周后,症状缓解.结论 EG浆膜型患儿常以大量腹水为首发症状,外周血和腹水中EOS计数明显增多,内镜下为非特异性表现,为黏膜充血水肿、糜烂、结节样增生等,胃肠黏膜多点活检病理可见固有层EOS浸润,饮食疗法、糖皮质激素治疗效果良好.     

嗜酸细胞性胃肠炎研究进展

嗜酸细胞性胃肠炎(eosinophilic gastroenteritis,EG)是一种少见的胃肠道疾病,以胃肠道某些部位弥漫性或局限性嗜酸性粒细胞(Eos)浸润为特征。胃和小肠为最常受累部位,可发生于任何年龄,其好发年龄为30～50岁,儿童时期较罕见,男性发病率高于女性。由于许多EG患者被误     

儿童蝇蛆病一例

患儿男,3岁5个月,藏族,来自四川省阿坝州.因"反复腹痛2个月,发热3 d"于2009年10月22日入院.2个月前患儿无明显诱因出现发热,伴腹痛,无吐泻.于当地医院就诊,血常规示嗜酸性粒细胞增高,达51%,骨髓检查示嗜酸性粒细胞增多,诊断"嗜酸性细胞增多症",予"阿奇霉素、泼尼松"治疗后体温恢复正常出院,院外继续服用"泼尼松5 mg,3次/d",1个月后于当地门诊复查血常规示嗜酸性粒细胞为3%,泼尼松逐渐减量,患儿仍有间歇性腹痛,但未再发热.     

认识嗜酸细胞性食管炎——从基因学、免疫学到临床诊治

在欧美国家中,嗜酸细胞性食管炎已成为一种常见的以严重嗜酸性粒细胞浸润为主的消化道疾病。其发病和食物过敏、支气管哮喘、特应性皮炎及其他过敏性疾病密切相关。Th2细胞在疾病的慢性炎症中起到了至关重要的作用。文章拟综述嗜酸细胞性食管炎的基础研究进展及临床治疗。     

儿童嗜酸细胞性膀胱炎诊治分析

目的 探讨儿童嗜酸细胞性膀胱炎的临床表现、诊断和治疗方法.方法 回顾性分析2001年12月至2009年2月本院收治的4例嗜酸细胞性膀胱炎患儿的临床资料.结果 患儿主要表现为明显的下尿路症状,通过膀胱镜检查和膀胱活检确诊,采用抗组胺药物和激素治疗效果满意,预后良好.结论 嗜酸细胞性膀胱炎是以嗜酸性粒细胞膀胱浸润为主要特征的临床少见疾病,明确诊断后治疗效果明显,预后良好.     

儿童嗜酸细胞性胃肠炎研究进展

儿童嗜酸细胞性胃肠炎(EG)是一种少见的胃肠道疾病.目前发病机制不甚明确,可能是对外源性或内源性变应原的全身或局部变态反应所致.嗜酸性粒细胞浸润的范围和深度导致该病临床表现的多样化.诊断的金标准取决于内镜多点活检、腹水找嗜酸性粒细胞及腹腔镜检查等.治疗主要有激素治疗及其他药物治疗.近年来对该病的临床诊治有许多新的观点,现就儿童EG临床研究进展作一综述.     

Acute acalculous cholecystitis with eosinophilic infiltration

We report a case of acute acalculous cholecystitis with eosinophilic infiltration. A previously healthy 6‐year‐old boy was referred with right abdominal pain. Imaging demonstrated marked thickening of the gallbladder wall and peri‐cholecystic effusion. Acute acalculous cholecystitis was diagnosed. Symptoms persisted despite conservative treatment, therefore cholecystectomy was performed. Pathology indicated infiltration of eosinophils into all layers of the gallbladder wall. The postoperative course was uneventful and the patient has had no further symptoms. Eosinophilic cholecystitis is acute acalculous cholecystitis with infiltration of eosinophils. The causes include parasites, gallstones, allergies, and medications. In addition, it may be seen in conjunction with eosinophilic gastroenteritis, eosinophilic pancreatitis, or both. An allergic reaction to abnormal bile is thought to be the underlying cause. The present case did not fulfill the diagnostic criteria of eosinophilic cholecystitis, but this may have been in the process of developing.     

Eosinophilic gastroenteritis in a patient with Albright's hereditary osteodystrophy

Eosinophilic gastroenteritis is an uncommon chronic disease, of unknown cause, characterized by eosinophilic infiltration of the gastrointestinal tract, which is usually associated with peripheral blood eosinophilia. The symptoms of this complex disorder are variable, and frequently include abdominal pain, nausea, diarrhea, protein losing enteropathy and malabsorption. In general, patients can be successfully treated with corticosteroids, but relapses are common. We present the first case of a 6-year-old boy with Albright's hereditary osteodystrophy (Pseudohypoparathyroidism Ia) associated with eosinophilic gastroenteritis. Alternatives to traditional treatment with corticosteroids are discussed.     

儿童嗜酸细胞性胃肠炎六例分析

目的 分析儿童嗜酸细胞性胃肠炎(EG)的诊治特点.方法 对2005年6月至2009年5月4年间北京儿童医院收治的6例EG患儿的临床表现、实验室检查、内镜、病理、骨髓细胞学以及诊治经过进行回顾性总结分析.结果 6例患儿男5例,女1例,年龄2～13岁;4例食物过敏原阳性;临床表现有腹痛、腹泻、呕吐、消化道出血等,腹腔积液4例.血嗜酸细胞绝对值5例升高[(160～13 560)×106/L],6例骨髓嗜酸细胞百分比均升高(0.18～0.41).影像学和内镜检查显示6例病变均累及胃和十二指肠,其他依次为肠系膜(5例)、小肠(4例)、结肠(3例)、食道(2例),病变局部表现有充血、糜烂、溃疡、胆汁反流、胃液潴留.病理表现为胃、十二指肠上皮糜烂,固有层大量嗜酸细胞浸润,散在淋巴细胞浸润,十二指肠改变更明显.激素治疗组3 d内消化道症状均消失,血嗜酸细胞计数在治疗1周时即恢复正常,非激素治疗组2周后症状才基本消失,血嗜酸细胞计数5周后仍未恢复正常.结论 EG与其他胃肠炎临床表现比无特殊,嗜酸细胞升高提示EG可能性,确诊需依靠病理检查,激素治疗在临床症状好转及外周血嗜酸细胞下降方面效果优于非激素治疗.     

Eosinophilic gastroenteropathy: a pediatric series

Eosinophilic gastroenteropathy (EoG) is an uncommon disease characterized by eosinophilic infiltration of the gastrointestinal (GI) mucosa. A chart review was performed searching for patients diagnosed between 2000 and 2010. EoG was diagnosed based on mucosal infiltration of 20 or more eosinophils/HPF in upper GI tract and more than 60 eosinophils/HPF in lower GI tract. Ten patients [median age: 10 mo. (r 2 mo.- 10 yr.)], 9 males, were diagnosed. Four presented with severe protracted diarrhea and weight loss, 2/10 abdominal distention and weight loss and 4/10 protein-losing enteropathy. Exclusive elemental or hypoallergenic diets were administered depending on the age of presentation with remission achieved in 4/10. Six required methylprednisolone to induce remission, 5 are still on budesonide. Due to the emergence of many cases of EoG in the last decade, we should increase our level of suspicion. Multicenter studies could contribute to define the best therapeutic approach for these patients.     

Blood eosinophils, leukotriene C4 generation, and bronchial hyperreactivity in formerly preterm infants.

Infants born prematurely are known to display longstanding bronchial hyperreactivity. The mechanism responsible for this is still unclear. Eosinophils are thought to play a central part in the development of bronchial hyperreactivity in asthma. It was the aim of this study to assess the relation of bronchial hyperresponsiveness to potential markers of eosinophilic inflammation in peripheral blood. Eosinophil count, the concentration of serum eosinophilic cationic protein, the capacity of purified eosinophils to generate leukotriene C4, and bronchial reactivity was studied in 24 non-atopic children born prematurely, 12 healthy controls, and 12 children with asthma aged 6 to 9 years. There was no difference in serum concentrations on eosinophil cationic protein and eosinophil counts. However, eosinophils from the 15 formerly preterm infants with significant bronchial hyperreactivity generated significantly higher amounts of leukotriene C4 than normal controls and prematurely born children without bronchial hyperreactivity. Levels of leukotriene C4 in this group were comparable with those obtained with eosinophils from patients with asthma. In contrast with cells from the other groups, eosinophils from the children with bronchial hyperreactivity born prematurely show no enhancement of leukotriene C4 generation on prestimulation with platelet activating factor. It is concluded that bronchial hyperreactivity of children born prematurely is accompanied by the prestimulation of eosinophils.     

Blood eosinophils, leukotriene C4 generation, and bronchial hyperreactivity in formerly preterm infants

Infants born prematurely are known to display longstanding bronchial hyperreactivity. The mechanism responsible for this is still unclear. Eosinophils are thought to play a central part in the development of bronchial hyperreactivity in asthma. It was the aim of this study to assess the relation of bronchial hyperresponsiveness to potential markers of eosinophilic inflammation in peripheral blood. Eosinophil count, the concentration of serum eosinophilic cationic protein, the capacity of purified eosinophils to generate leukotriene C4, and bronchial reactivity was studied in 24 non-atopic children born prematurely, 12 healthy controls, and 12 children with asthma aged 6 to 9 years. There was no difference in serum concentrations on eosinophil cationic protein and eosinophil counts. However, eosinophils from the 15 formerly preterm infants with significant bronchial hyperreactivity generated significantly higher amounts of leukotriene C4 than normal controls and prematurely born children without bronchial hyperreactivity. Levels of leukotriene C4 in this group were comparable with those obtained with eosinophils from patients with asthma. In contrast with cells from the other groups, eosinophils from the children with bronchial hyperreactivity born prematurely show no enhancement of leukotriene C4 generation on prestimulation with platelet activating factor. It is concluded that bronchial hyperreactivity of children born prematurely is accompanied by the prestimulation of eosinophils.     

Eosinophilic gastroenteritis with involvement of the urinary bladder

Eosinophilic gastroenteritis with eosinophilic infiltration of the urinary bladder wall is rare in children. We describe the CT findings of eosinophilic gastroenteritis accompanied by bladder involvement in an 11-year-old boy. CT imaging showed diffuse wall thickening of the entire gastrointestinal tract from the esophagus to the colon and revealed a halo sign, irregular fold thickening and luminal narrowing without obstruction of the gastrointestinal wall. Another CT finding was the diffuse thickening of the bladder wall with moderate enhancement on postcontrast CT. The boy underwent endoscopic biopsy from various sites of the gut wall and histology revealed increased eosinophiliac infiltration in the mucosa. After corticosteroid therapy, the boy recovered gradually. The case emphasizes that not only the gastrointestinal tract but also the urinary bladder may be involved in children with eosinophilic gastroenteritis and that recognition of CT features of this disease aids in early diagnosis and therapy.     

An unusual presentation of thoracic para-aortic hematoma due to blunt trauma

An 11-yr-old boy was admitted to the hospital with gradually aggravating acute abdominal pain along with nausea, vomiting and constipation for 5 days. The pain started after blunt trauma on the superior abdomen. He had normal laboratory tests and abdominal examination, but his chest radiograph showed infiltration in the right lung and an abnormal mass on the left diaphragm. Further investigation like computed tomography (CT) and magnetic resonance MR angiography, revealed an abnormal para-aotic mass located a mass located para-aortic above posterior to the left diaphragm with a well-defined margin. The abnormal mass was finally confirmed to be a hematoma with exploratory thoracotomy. The rarity of this kind of presentation is discussed for making an early and correct diagnosis.     

Intestinal Perforation in a Two-Year-Old Child with Eosinophilic Gastroenteritis

ABSTRACT. A two-year-old boy underwent a laparatomy for an intestinal perforation due to eosinophilic gastroenteritis. He had marked peripheral blood eosinophilia and a small duodenal biopsy showed heavy eosinophilic infiltration in the mucosa. After 1 1/2 year on a restricted diet, a control duodenal biopsy showed only slight eosinophilia. Perforation of the small intestine is a rare but serious complication in eosinophilic gastroenteritis.