以腹水为主要表现的嗜酸细胞性胃肠炎临床分析

目的探讨嗜酸细胞性胃肠炎（EG）的临床特征,提高对以腹水为主要表现的EG的识别。方法对我院1995年3月-2011年5月收治的15例EG患者的临床资料进行系统性回顾分析。结果 15例EG患者主要表现为腹痛（15/15,100%）、腹泻（11/15,73.3%）、腹胀（8/15,53.3%）、恶心（2/15,13.3%）等。其中3例（20.0%）主要表现为腹水,1例（6.7%）表现为不全性肠梗阻。所有患者外周血嗜酸细胞明显增高,其百分比为9.8%～63.7%,平均（27.2±13.6）%;绝对计数为（1.1～6.0）×109/L,平均（3.1±1.4）×109/L。15例胃镜检查中,13例（86.7%）显示胃窦、十二指肠有不同程度充血、水肿、糜烂,其中1例为十二指肠球部溃疡;7例肠镜检查患者中,5例（71.4%）结肠黏膜出现类似改变,并以回盲部多见。活检组织病理学检查均见大量嗜酸细胞浸润。3例腹水均为渗出液,腹水中嗜酸细胞占白细胞总数的36%～65%,平均（53±15.1）%。所有患者均经泼尼松治愈,疗程32～60 d。结论 EG临床表现呈多样性,无特异性。腹水型患者少见,不易早期诊断。治疗主要应用糖皮质激素,预后良好。     

Esophageal eosinophilia after radiofrequency ablation for Barrett's esophagus

Radiofrequency ablation (RFA) with HALO system has been developed as a new treatment option for Barrett's esophagus (BE). It had been observed that some patients had esophageal eosinophilia (EE) infiltration after RFA. The incidence and features of EE after RFA were systematically determined. From a prospectively compiled database, data on 148 patients who underwent RFA for BE were analyzed. Biopsies were taken pre‐ and post‐RFA from the BE segment, and histological sections of the biopsy specimens were stained with hematoxylin and eosin, and examined by a gastrointestinal pathologist. The incidence of EE post‐RFA was then determined. Of the 148 patients, 120 (81%) were men, 137 (92%) were white, 64 (43%) were overweight and 49 (33%) obese, and 128 (86%) were over 50 years of age or more. Four (2.7%) of the patients developed post‐RFA EE, but none had symptoms of eosinophilic esophagitis. All patients except one had a history of seasonal allergies. All four were taking proton pump inhibitor before and after RFA. Two patients with EE drank alcohol, one of which was a smoker. EE is a potential adverse event of RFA for BE. The absence of esophageal dysfunction symptoms suggests a different clinicopathological entity from eosinophilic esophagitis. Further studies should be done to assess its clinical significance, if therapy is needed, or if it may eventually lead to eosinophilic esophagitis.     

Management of proton pump inhibitor responsive-esophageal eosinophilia and eosinophilic esophagitis: controversies in treatment approaches

Eosinophilic esophagitis (EoE) is a chronic immune-mediated clinicopathologic disease. The prevalence of EoE is approximately 1/2000 persons, EoE is now the most common cause of food impactions, with healthcare expenditures approaching US$ 1 billion annually. This article will discuss challenges related to proton pump inhibitor responsive esophageal eosinophilia, including distinguishing this condition from EoE and understanding the mechanisms behind the PPI response. For EoE, we will review multiple ongoing debates about treatment and monitoring strategies, including selecting treatment outcomes, optimizing medication formulations, approaching the steroid-refractory patient, conducting dietary elimination, prescribing long-term maintenance therapy and performing esophageal dilation.     

Computer analysis of upper gastrointestinal endoscope images

Gastro‐oesophageal reflux disease (GORD) occurs in up to 40% of adults in the West. Oesophagitis is a major determinant in the treatment of GORD but its current classification systems are subjective. In order to help to provide objective interpretation of upper gastro‐intestinal (GI) endoscope examination and reduce inter‐observer variability, we developed a computer image analysis system. Digital video recordings were made on patients with clinical evidence of reflux oesophagitis. Cross‐sectional profiles of hue and saturation data were analysed on images from seven patients with grade B or C oesophagitis (LA grading). This analysis showed clear changes in hue (p?=?0.01) and saturation (p?=?0.001). These results suggest that quantification of upper GI endoscopic images is feasible and may help in objective assessment.     

Oesophageal acid exposure: higher in Barrett's oesophagus than in reflux oesophagitis

Oesophageal acid exposure at different pH intervals between 0 and 8 in patients with Barrett's oesophagus (n = 24) was compared with that in patients with reflux oesophagitis (n = 19) by using 24-h pH monitoring. Prior to the monitoring, the position and pressure of the lower oesophageal sphincter was measured by manometry. Columnar epithelium with intestinal metaplasia and goblet cells was verified histologically in all Barrett patients and grade I—III oesophagitis in patients with reflux oesophagitis. Acid exposure (percentage of total time at pH < 4) in the Barrett group was significantly greater than in the oesophagitis group: 21.5 ± 20.0% SD vs 11.1 ± 11.7% SD (P < 0.01). The number of reflux episodes lasting longer than 5 min (representing oesophageal body clearance function) was also significantly greater in the Barrett group (8.3 ± 5.9 SD) than in the oesophagitis group (4.5 ± 4.7 SD) (P < 0.01). In the Barrett group the acid exposure time was greater at all pH intervals 0-1, 1-2, 2-3 and 3-4, (P < 0.01) but in the oesophagitis group the exposure time was greater at pH interval 5-6 (P < 0.01). There was no significant difference in exposure at pH values above 7. The mean lower oesophageal sphincter pressure was equal in both groups (11.0 vs 11.9 mmHg). In conclusion, oesophageal acid exposure was significantly greater in Barrett's oesophagus than in reflux oesophagitis, and this was associated with decreased oesophageal clearance function. In addition, the results indicated the need for special attention and perhaps higher dosages of drugs to suppress acid production in patients with Barrett's oesophagus.     

Eosinophilic esophagitis: an update

Eosinophilic esophagitis (EE) is a disease that is being recognized with increasing frequency. In children it is responsible for feeding disorders, vomiting, reflux symptoms and abdominal pain and in adults it causes dysphagia and esophageal food impactions. The diagnosis requires the histologic finding of > 20 eosinophils per high powered field in esophageal squamous mucosa. The most common treatment regimens in children and adults involve the ingestion of topical corticosteroids. Symptomatic relapse after one treatment course is common, and many patients require repeated courses of treatment. The long-term prognosis of EE is largely unknown.