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Objective To discuss the clinical manifestations, laboratory indexes, imageological ex-amination results,endoscopic and histopathological features of eosinophilic gastroenteritis( EG) in children. Methods Thirty-three children with EG were collected with clinical manifestations,allergic history,labora-tory examination,endoscopic and histopathological features and treatments,who were hospitalized at depart-ment of pediatric gastroenterology of Shengjing Hospital of China Medical University between January 2012 and December 2017. Results The main clinical manifestations of EG were abdominal pain(75. 8％),vomi-ting(30. 3％)and diarrhea(21. 2％). The hemoglobin level decreased in 7 cases(21. 2％). The eosinophil count increased in 13 cases ( 39. 4％) . Total serum IgE elevated in 18 cases ( 54. 5％) , while 23 cases were positive in serum food or respiratory specific IgE. The fecal occult blood test showed positive in 7 cases (21. 2％). Among 28 children conducted with whole abdominal CT,there were 13 cases of pelvis fluid, 12 cases of enlarged lymph nodes and 4 cases of thickened intestinal wall. All 33 children went through the endoscopic examination,the main histological change were erythema-exudation(31 cases,93. 9％),mucosal hyperemia edema(5 cases,15. 2％) and hemorrhage(4 cases,12. 1％). The main pathological change was mucosal inflammation with a large number of eosinophil infiltration(≥20 per HPF) . Among the 33 cases,17 cases relieved through treatment of avoiding allergen, antacids, anti-allergic agents and leukotriene receptor antagonist,with 1 case recurrence. The other 16 cases relieved after treatment of glucocorticoid and the above therapy,with 3 cases recurrence. Conclusion The clinical manifestations of children with EG are various and lack of specificity. In terms of diagnosis,the elevated level of eosinophil count and total serum IgE,or posi-tive in serum food specific IgE may be taken as reference. The definite diagnosis is based on pathological examination (eosinophil infiltration≥20 per HPF). For treatment,avoiding allergen,antacids,anti-allergic agents and leukotriene receptor antagonist are effective in several children. Glucocorticoid can obtain satisfac-tory curative effect in the uneffective children.
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Objective Through the TNBS-induced inflammatory bowel disease model in young rats,to observe the level of Th17 cell related cytokine IL-17A on the intestinal tissue of IBD young rats model after feeding EEN,Peptisorb,and investigate the enteral nutrition's regulative effects on Thl7 cells.Methods Thirty six four-week healthy male Sprague-Dswley rats were selected and divided into 4 groups,blank control group and EEN control group with 8 rats in each group,IBD group and IBD-EEN group with 10 rats in each group:blank control group and EEN control group were given normal saline enema,then fed with normal diet and enteral nutrition separately;IBD group and IBD-EEN group were given 5％ TNBS enema,establish the IBD model,then fed with normal diet and enteral nutrition separately.The weights,defecate characters and occult blood situations of all rats were determined.Also,we carried out the activity index score of disease according to the Cooper score method.On the seventh day,all rats were sacrificed and the colon specimens were collected.We observed mucosal injury by HE staining and expression level of Thl7 cell related cytokine IL-17A that were detected by immunohistochemical staining.Results Compared with IBD group,IBD-EEN group was improved significantly in terms of defecate character and occult blood situation.Both IBD group and IBD-EEN group gained their body weights than before,(39.95 ± 2.929) g and (38.40 ± 4.545) g respectively after 7 days (P≥0.05).In IBD group,gross tissue and pathological section displayed significant intestinal inflammation change,showing typical inflammatory bowel disease change;under the microscope,intestinal mucosa showed a large amount of inflammatory cell infiltration,a part of section displayed inflammatory granuloma formation,normal glandular structure was damaged.After EEN treatment,DAI scores werr decreased significantly;intestinal inflammation changes were relieved;intestinal mucosa inflammatory cell infiltration were reduced.Immunohistochemical study showed that the expression of IL-17A cytokine in the intestinal mucosa of IBD group was higher than that of IBD-EEN group (P ＜ 0.05).Conclusion The exclusive enteral nutrition treatment possessed the effect of reducing IBD young rat's intestinal mucosal inflammation,the inner mechanism may be related with the changing expression of Th17-cell cytokines,IL-17A.
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Objective To discuss the clinical feature of cholestasis preterm infants who have used parenteral nutrition early after birth,and analyze the relative factors and preventive meatures of parenteral nutrition associated cholestasis (PNAC).Methods We retrospectively analyzed the preterm infants who were born and hospitalized at Shengjing Hospital of China Medical University from January,2011 to April,2016.There were 89 cases in total that used at least 2 weeks of parenteral nutrition in the early stage after birth and were developed to cholestasis afterwards.We divided 89 cases into PNAC group and multifactor group:the former was corresponded to PNAC diagnosis standards,accounting for41 cases (46.07％);the latter with other etiology in addition to parenteral nutrition accounts for 48 cases.The clinical characteristics were studied and analyzed using case-control method.Results The sex ratio of premature cholestasis was 2.18:1,the mean gestational age was (31.05 ±2.15) weeks,the mean birth weight was (1360.55 ±421.14) g,and the mean using-time of parenteral nutrition was (26.22 ± 9.78) d.Futhermore,PNAC group was divided into hepatitis group and non-hepatitis group according to the alanine aminotransferase level,and they both had statistical significance in gestational age,starting time of parenteral nutrition,appearance time of jaundice,enteral feeding time,starting dose of amino acid,maximum dose of fat emulsion (P ＜ 0.05).We divided them into long-term group (≥20 d) and short-term group (＜ 20 d) according to the using time of parenteral nutrition.The level of alanine aminotransferase,glutamic oxalacetic transaminase,total bilirubin,direct bilirubin and bile acid of longterm group was higher than those of short-term group,but with P≥0.05.The multifactor group was mostly accompanied with multiple infections in the order of bacterial infection (75.0％),fungal infection (20.83％),cytomegalovirus infection (8.33％) and syphilis infection (2.08％),etc.The other complication's incidence rate of PNAC group and multifactor group had no statistical significance.In terms of prognosis,the liver function of two group improved remarkably than before,with PNAC group having more significance (P ＜0.05).Conclusion PNAC is the major factor of preterm cholestasis,and the degree of liver damage of PNAC preterm was related to starting time of parenteral nutrition,using time of parenteral nutrition,enteral feeding time,starting dose of amino acid and maximum dose of fat emulsion.The liver function of PNAC group is recovered obviously through regulatory treatment,and it possesses a better prognosis than multifactorgroup.