Subserous Eosinophilic Colitis: A Case Report in a Private Hospital in Lima, Peru

Eosinophilic colitis is a rare gastrointestinal disease that belongs to the group of so-called primary eosinophilic diseases of the digestive tract. There are three types: mucosa, transmural (muscular), and subserous. We present the case of a 23-year-old male patient with a clinical picture of abdominal pain, nausea, chronic diarrhea, and ascites. Parasitic and other secondary etiologies were ruled out. Upper digestive endoscopy was not helpful. Colonoscopy revealed characteristics of inflammation in the distal ileum and ascending colon, the histological findings of which were consistent with eosinophilic colitis. The study of ascitic fluid was suggestive of eosinophilic ascites. The patient received induction treatment with prednisone 40 mg daily orally; remission was achieved after two weeks, and maintenance therapy based on prednisone was continued with the progressive withdrawal of the dose. Control of the disease was successful.

La colitis eosinofílica es una patología gastrointestinal infrecuente que pertenece al grupo de las denominadas enfermedades primarias eosinofílicas del tracto digestivo. Existen 3 tipos: mucosa, transmural (muscular) y subserosa. Presentamos el caso de un paciente varón, de 23 años de edad, con un cuadro clínico de dolor abdominal, náuseas, diarrea crónica y presentación de ascitis. Se descartan etiologías parasitarias y otras secundarias. La endoscopia digestiva alta no fue contribuidora. Mediante una colonoscopia se observaron características de inflamación en el íleon distal y el colon ascendente, cuyos hallazgos histológicos son compatibles con colitis eosinofílica. El estudio de líquido ascítico es sugestivo de ascitis eosinofílica. El paciente recibió tratamiento de inducción con prednisona a 40 mg diarios por vía oral, se logró la remisión a las 2 semanas y se continuó con terapia de mantenimiento a base de prednisona con retiro progresivo de la dosis. Se logró el control de la enfermedad de manera exitosa.

Eosinophilic Gastroenteritis: An Unclear Etiology of Ascites and Dramatic Response to Steroids Can be a Diagnostic Key

Eosinophilic gastroenteritis disorder is an uncommon inflammatory disorder of the gastrointestinal tract, affecting predominantly, stomach and small intestine. Subserosal inflammation is a major source of minor?to?moderate ascites. We present the case of an 8?year?old girl child who was brought to the hospital with complaints of chronic abdomen pain and mild ascites. There was a remarkable finding of eosinophils in ascitic fluid. Other differential diagnosis was excluded. Treatment abdomen with deflazacort gave significant resolution of symptoms over the time.

Comparative analysis of clinical characteristics between children and adults with eosinophilic gastroenteritis / 中华消化杂志

Objective:To explore the similarities and differences between children and adults with eosinophilic gastroenteritis (EGE), and to guide the diagnosis and treatment of EGE.Methods:From February 2013 to August 2018 at Xi′ an Children′ s Hospital, 18 children with EGE (child group) and from June 2008 to June 2018 at Xijing Hospital of Digestive Diseases, Air Force Medical University, 24 adults with EGE (adult group) were retrospectively selected as study subjects. The general data, clinical symptoms, laboratory examinations, imaging, endoscopy manifestations, pathological biopsy, treatment and prognosis of the two groups were analyzed. Chi-square test was used for statistical analysis. Results:The proportion of child group with allergic history was higher than that of adult group (9/18 vs. 20.8%, 5/24), the incidence of nausea and vomiting was higher than that of adult group (13/18 vs. 29.2%, 7/24), the incidence of diarrhea and weight loss were both lower than those of adult group (4/18 vs. 58.5%, 14/24; 3/18 vs. 54.2%, 13/24), and the proportion of patients with elevated peripheral blood eosinophil count was lower than that of adult group (4/18 vs. 58.3%, 14/24), and the differences were statistically significant ( χ2=3.938, 7.644, 5.477, 6.133 and 5.477, P=0.047, 0.006, 0.019, 0.013 and 0.029). The main endoscopic manifestations of the two groups were mucosal congestion and edema (13 cases of child group and 22 cases of adult group). Mucosal roughness (7 cases) and erosion (6 cases) were also common in child group, while mucosal erosion (18 cases, 75.0%) and ulcer (8 cases, 33.3%) were more common in adult group. There was a statistically significant difference in the incidence of mucosal erosion between the two groups ( χ2=7.292, P=0.007). The positive rates of biopsy in the terminal ileum, colorectum and duodenum of child group and adult group were both high (6/6, 14/15, 9/18 and 8/10, 12/15, 6/8, respectively). The response time of glucocorticoid treatment was 4.5 d (2.0 to 27.0 d) and 3.7 d (1.0 to 14.0 d) in child group (8 cases) and adult group (13 cases), respectively. There was no statistically significant difference in the recurrence rate after glucocorticoid treatment between the two groups (5/8 vs. 6/13, P > 0.05). Conclusions:The clinical characteristics of children and adults with EGE are different, which may provide references for clinicians to understand, diagnose and treat EGE.

Correlation between T follicular helper cells and eosinophilic gastroenteritis in children / 中华实用儿科临床杂志

Objective:To investigate the role and clinical significance of T follicular helper (Tfh) cells in the pathogenesis of eosinophilic gastroenteritis (EG) in children.Methods:A total of 17 children diagnosed with EG in the Department of Gastroenterology, Children′s Hospital of Nanjing medical University from October 2018 to January 2020 were recruited as EG group.During the same period, 15 children diagnosed with colon polyps were included as control group.Flow cytometry was used to detect Tfh cells and their functional molecules, including inducible costimulatory molecules (ICOS) and programmed cell death protein 1 (PD-1) in peripheral blood of the 2 groups.Results:The median (interquartile range) of Tfh cell frequency in peripheral blood of children with EG group was 7.3 (2.6)%, which was significantly higher than that of controls 2.8 (1.4)% ( P<0.05). There were significant differences in the median (interquartile range) of ICOS [1.5 (1.3)% vs.0.1 (0.2)%] and PD-1 expressions [1.8 (3.2)% vs.0.7 (0.6)%] on Tfh cells between children with EG group and control group (all P<0.05). The frequency of Tfh cells in the peripheral blood of children with EG was positively correlated with the expressions of ICOS ( r=0.746, P<0.05) and PD-1 ( r=0.893, P<0.05), and immunoglobulin E (IgE) level ( r=0.587, P<0.05). Conclusions:The frequency of Tfh cells in peripheral blood of children with EG significantly increases, which are proliferative and overexpressed with ICOS and PD-1.Moreover, the frequency of Tfh cells of EG patients is positively correlated with the level of IgE.The abnormal expression of Tfh cells may play a promoting role in the mechanism of EG.

Recurrent abdominal pain, peritoneal effusion, and eosinophilia in a boy aged 17 years / 中国当代儿科杂志

A boy, aged 17 years, was admitted again due to abdominal pain, diarrhea, and eosinophilia for 3 years, which worsened for 3 days. Three years ago, the boy suffered from abdominal pain and diarrhea after eating yogurt; color Doppler ultrasound showed a large amount of peritoneal effusion, and routine blood test, bone marrow cell morphology, and ascites histological examination showed a large number of eosinophils. Three days ago, he was admitted again due to abdominal pain and diarrhea. The gastrointestinal endoscopy showed eosinophil infiltration in the angle of stomach. The boy was diagnosed with eosinophilic gastrointestinal disease (eosinophilic gastroenteritis). He was improved after the treatment with glucocorticoids and dietary avoidance, and no recurrence was observed during the one-year follow-up. It is concluded that for children who attend the hospital due to gastrointestinal symptoms such as abdominal pain and diarrhea, if there is an increase in peripheral blood eosinophils, it is necessary to consider the possibility of eosinophilic gastrointestinal disease, and eosinophil infiltration and abnormal eosinophil count in gastrointestinal tissue based on endoscopic biopsy may be the key to diagnosis.

Predictive factors for glucocorticoid therapy in children with eosinophilic gastroenteritis / 中国当代儿科杂志

OBJECTIVES@#To study the predictive factors for glucocorticoid therapy by analyzing the association between the clinical features and treatment regimens in children with eosinophilic gastroenteritis.@*METHODS@#A retrospective analysis was performed on the medical data of 182 children with eosinophilic gastroenteritis who were admitted to Guangzhou Women and Children's Medical Center from January 2012 to December 2020. According to whether glucocorticoids were used, these children were divided into a glucocorticoid treatment group and a control group. The two groups were compared in terms of age, history of allergy, clinical symptoms, laboratory examination results, endoscopic findings, and pathological results of gastrointestinal mucosa. A multivariate logistic regression analysis was performed for the results with statistical significance.@*RESULTS@#Of the 182 children, 36 (19.8%) received glucocorticoid therapy. The rates of hematochezia, anemia, and mucosal ulceration/luminal stenosis under endoscopy and the mucosal eosinophil infiltration count were significantly higher in the glucocorticoid treatment group than those in the control group (@*CONCLUSIONS@#Mucosal ulceration/luminal stenosis under endoscopy or a significant increase in the mucosal eosinophil infiltration count based on pathology suggests that glucocorticoid therapy can be considered in children with eosinophil gastroenteritis.

Abnormal thymic stromal lymphopoietin expression in the gastrointestinal mucosa of patients with eosinophilic gastroenteritis / Expressão anormal da linfopoietina estromal tímica na mucosa gastrointestinal depacientes com gastroenterite e osinofílica

Abstract Objective: To investigate the differential expression of the thymic stromal lymphopoietin isoforms, short and long, and discern their biological implications under eosinophilic gastroenteritis. Methods: The expression of thymic stromal lymphopoietin and its two isoforms in tissues was assessed by quantitative RT-PCR in healthy controls (n = 24) and patients with eosinophilic gastroenteritis (n = 17). Results: Thymic stromal lymphopoietin mRNA was significantly reduced in eosinophilic gastroenteritis when compared with healthy controls (p < 0.0001). A significantly lower amount of short thymic stromal lymphopoietin mRNA was observed in eosinophilic gastroenteritis when compared with controls (p < 0.05), while a significantly higher amount of long thymic stromal lymphopoietin mRNA was observed in eosinophilic gastroenteritis when compared with controls (p < 0.05). Peak eosinophilic count is significantly positively correlated with the expression of long thymic stromal lymphopoietin mRNA in the gastrointestinal mucosal of patients with eosinophilic gastroenteritis (r s = 0.623, p < 0.005), while peak eosinophilic count is significantly negatively correlated with the expression of short thymic stromal lymphopoietin mRNA in the gastrointestinal mucosal of patients with eosinophilic gastroenteritis (r s = −0.4474, p < 0.05). Conclusions: Abnormal mucosal thymic stromal lymphopoietin expression may contribute to gastrointestinal mucosa damage in eosinophilic gastroenteritis.

Resumo Objetivo: Investigar a expressão diferencial das isoformas da linfopoietina estromal tímica, curta e longa, e discernir suas implicações biológicas na gastroenterite eosinofílica. Métodos: Avaliamos a expressão das isoformas da linfopoietina estromal tímica e suas duas isoformas através da técnica RT-PCR quantitativa em tecidos de controles saudáveis (n = 24) e pacientes com gastroenterite eosinofílica (n = 17). Resultados: Demonstramos que o RNAm das isoformas da linfopoietina estromal tímica estava significativamente reduzido na gastroenterite eosinofílica em comparação com os controles saudáveis (p < 0,0001). Também descobrimos uma quantidade significativamente menor de RNAm das isoformas da linfopoietina estromal tímica curta na gastroenterite eosinofílica em comparação com os controles (p < 0,05) e uma quantidade significativamente maior de RNAm das isoformas da linfopoietina estromal tímica longa na gastroenterite eosinofílica em comparação com os controles (p < 0,05). O pico da contagem eosinofílica está correlacionado positiva e significativamente com a expressão do RNAm das isoformas da linfopoietina estromal tímica longa na mucosa gastrointestinal de pacientes com gastroenterite eosinofílica (rs = 0,623, p < 0,005), enquanto o pico de contagem eosinofílica está negativa e significativamente correlacionado com a expressão do RNAm das isoformas da linfopoietina estromal tímica curta na mucosa gastrointestinal de pacientes com gastroenterite eosinofílica (rs = -0,4474, p < 0,05). Conclusões: A expressão anormal das isoformas da linfopoietina estromal tímica na mucosa pode contribuir para o dano da mucosa gastrointestinal na gastroenterite eosinofílica.

Eosinophilic gastroenteritis with persistent abdominal pain: a case report / Journal of Rural Medicine

Two months ago, a 9-year-old boy experienced intermittent abdominal pain regardless of food intake, without diarrhea, bloody stool, or nausea. Blood test results revealed a peripheral blood eosinophil count of 660 cells /µL, which was marginally elevated, without inflammatory reaction, occult blood, or enteric pathogens. The intestinal mucosa from the terminal ileum to the rectum was endoscopically normal, but mucosal biopsy revealed eosinophilic infiltration of the terminal ileum and whole colon with ≥20 eosinophils/high power field (HPF). Subsequent upper gastrointestinal endoscopy revealed normal endoscopic mucosa from the esophagus to the second part of the duodenum, but mucosal biopsy showed an eosinophil infiltration of ≥20 eosinophils/HPF. Based on the above findings, he was diagnosed with eosinophilic gastroenteritis (EGE). The cause of EGE and mechanisms of eosinophil infiltration have yet to be fully elucidated. For these nonspecific abdominal symptoms, evidence of eosinophilic infiltration of the gastrointestinal mucosa, specifically 20 eosinophils/HPF in each intestinal mucosa, is required for the definitive diagnosis of EGE. Even if only persistent abdominal pain develops, EGE diagnosis should be confirmed with the analysis of mucosal biopsy in addition to the review of allergic disease history and peripheral blood eosinophil counts.

Research progress in diagnosis and treatment of eosinophilic gastroenteritis / 上海交通大学学报（医学版）

Eosinophilic gastroenteritis (EGE) is a rare chronic disease of digestive system, characterized by the eosinophil infiltration of the gastrointestinal tract and the thickening of the gastrointestinal wall. At present, the etiology and pathogenesis of EGE are still unclear. Accompanied with eosinophilia and elevation of serum immunoglobulin E, the clinical manifestations of EGE are dependent on the location of lesions and the extent or depth of eosinophil infiltration in the gastrointestinal tract. The thickening or edema of the gastrointestinal wall, nodular-like changes, intestinal stenosis and ascites can be regarded as common radiological findings of EGE, while erythema, hyperemia or edema, erosion and ulcer of mucosal are the endoscopic features of EGE. Tissue biopsy is helpful for the diagnosis of EGE. However, with unspecific clinical manifestations, laboratory tests, radiological and endoscopic findings and unidentified cut-off count of pathological diagnostic criteria, EGE is very difficult to be diagnosed. Therefore, this paper mainly reviews the research progress in the diagnosis and treatment of EGE, attempting to improve the clinicians' understanding of EGE.

Colitis eosinofílica como causa de diarrea crónica / Eosinophilic colitis as a cause of chronic diarrhea

Resumen La colitis eosinofílica es una enfermedad rara e idiopática caracterizada por la infiltración eosinofílica del colon y que hace parte del espectro de la gastroenteritis eosinofílica. Esta entidad tiene síntomas inespecíficos y en la actualidad no hay estudios clínicos, por lo cual la evidencia científica se basa en series de casos o reportes aislados. Esta patología requiere de un enfoque diagnóstico adecuado para descartar otras causas de eosinofilia en el colon, para poder así ofrecer un manejo farmacológico y no farmacológico dirigido y especializado para lograr la remisión de la enfermedad, por lo cual para ofrecer una atención oportuna, se debe tener en cuenta dentro del diagnóstico diferencial de aquellos pacientes jóvenes con diarrea crónica para lograr mejorar el enfoque diagnóstico y promover la realización de estudios clínicos que mejoren la calidad de la evidencia científica actual. Presentamos el primer caso con compromiso exclusivo del colon reportado en Colombia de una mujer con antecedente de enfermedades atópicas. (Acta Med Colom 2019; 44: 47-50)

Abstract Eosinophilic colitis is a rare and idiopathic disease characterized by eosinophilic infiltration of the colon and is part of the spectrum of eosinophilic gastroenteritis. This entity has nonspecific symptoms and currently there are no clinical studies, so the scientific evidence is based on case series or isolated reports. This pathology requires an adequate diagnostic approach to rule out other causes of eosinophilia in the colon, in order to offer a directed and specialized pharmacological and non-pharmacological management to achieve remission of the disease, so that to offer timely care it should be considered in the differential diagnosis of those young patients with chronic diarrhea in order to improve the diagnostic approach and promote performance of clinical studies that improve the quality of current scientific evidence. This is the first case with exclusive involvement of the colon reported in Colombia of a woman with a history of atopic diseases. (Acta Med Colom 2019; 44: 47-50)

Clinical Analysis of 24 Cases of Eosinophilic Gastroenteritis / 胃肠病学

Background: Eosinophilic gastroenteritis (EGE) is a rare gastrointestinal disorder characterized by eosinophilic infiltration of the gastrointestinal tract. Up to now, most of the knowledge of EGE is based on single case reports and small sample studies at home and abroad. Aims: To study the clinical manifestations, endoscopic characteristics, histo-pathological features, as well as treatment and relapse of EGE. Methods: A retrospective analysis was conducted on the clinical data of patients with EGE from Nov. 2008 to Jun. 2018 at the Xijing Hospital of Digestive Diseases. Results: Twenty-four patients with EGE were identified (mean age 44.4 years). The disease affected both males and females with a slight male predominance (1.4:1). Atopy or allergic disorders were present in 5 cases (20.8%); 13 cases (54.2%) had obvious inducing factors, including 11 cases related to improper eating. Most common symptoms were abdominal pain (66.7%) and diarrhea (58.3%). Peripheral eosinophilia occurred in 14 patients (58.3%). Abdominal ultra-sonography/CT demonstrated 3 cases of massive ascites. Mucosal congestion, edema, erosion and ulcer were the predominant features seen on endoscopy. The colorectum (80.0%), terminal ileum (80.0%) and duodenum (75.0%) were the most common sites involved in biopsy pathology. Based on depth of eosinophilic infiltration, 19 were mucosal (79.2%), 2 were muscularis (8.3%), and 3 were subserosal diseases (12.5%). Glucocorticoids combined with symptomatic treatment could rapidly improve symptoms, however, the recurrence rate (mainly due to improper eating and drug withdrawal) was substantially high (52.6%). Conclusions: EGE is a rare condition with high relapse rate. Glucocorticoids with symptomatic treatment are effective in relieving symptoms. When EGE is suspected, both gastroscopy and colonoscopy should be performed and multiple biopsies should be taken, especially in colorectum, terminal ileum and duodenum to improve the detection rate.

Clinical analysis of eosinophilic gastroenteritis in children / 中国小儿急救医学

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.

Eosinophilic gastroenteritis in an immunosuppressed patient: a case report

Eosinophilic gastroenteritis is a rare disease that is characterized by Eosinophil infiltration in one or multiple segments of the gastrointestinal tract. The etiology of this condition remains unknown. Eosinophilic gastroenteritis has heterogeneous clinical manifestations that depend upon the location and depth of infiltration in the gastrointestinal tract, and eosinophilia may or may not be present. This article reports a case of Eosinophilic Gastroenteritis in a 57 years old retroviral male patient, who presented with chronic diarrhea, bilateral pedal edema and eosinophilia. Ultimately, the diagnosis of eosinophilic gastroenteritis was clinched. The rare character of eosinophilic gastroenteritis and its varied clinical presentations often lead to delayed diagnosis and complications. Case reports may help to disseminate knowledge about the disease, thereby increasing the likelihood of early diagnosis and intervention to prevent complications.

A retrospective analysis of clinical characteristics and prognosis of 17 patients with eosinophilic gastroenteritis / 第二军医大学学报

Objective To analyze the clinical characteristics of eosinophilic gastroenteritis (EG) so as to provide evidence for early diagnosis and treatment of EG. Methods The clinical data of 17 patients with EG, who were admitted to Changzheng Hospital of Second Military Medical University from Jul. 2009 to Jan. 2017, were retrospectively analyzed. Results Male patients had a higher prevalence of EG and occurrence ratio of male and female was 2.4∶1. Nine (52.9%) of the 17 patients had a history of allergy. The most common symptoms were abdominal pain (13/17, 76.5%), followed by abdominal distension (7/17, 41.2%). Peripheral eosinophil count elevated in the 17 patients. Endoscopic examination showed that the lesions were mainly located in the gastric antrum, gastric body and descendant duodenum, and the most common finding were mucosal erythema. Biopsy of 13 cases and/or ascites examination of 5 cases showed eosinophil infiltration in the lesions. Abdominal CT scanning of 8 cases showed stomach or partial small bowel wall thickening with edema and thickened mesenterium. Glucocorticoid therapy was the main treatment for EG, and it could effectively relieve the symptoms. Seven of 13 cases who were followed up had relapse, with the recurrence rate being 53.8% (7/13), and were improved after administration of glucocorticoid again. Conclusion The clinical manifestation of EG is non-specific, and the endoscopic multi-point biopsy is the key to diagnose EG. Glucocorticoid can effectively relieve symptoms of EG and reduce peripheral eosinophils count.

Experience in Treating Eosinophilic Gastroenteritis with Banxia Xiexin Decoction / 中国中医药信息杂志

The most common manifestations of eosinophilic gastroenteritis (EG) are abdominal pain and diarrhea. Glucocorticoid is currently used in the treatment for EG, but the adverse reactions are relatively large. Banxia Xiexin Decoction is the famous Zhongjing prescription can be used to treat many kinds of gastrointestinal diseases. This article introduced. Banxia Xiexin Decoction combined with Shaoyao Gancao Decoction in the treatment of abdominal pain predominant based EG, as well as Banxia Xiexin Decoction combined with Gegen Qinlian Decoction in treating diarrhea predominant based EG have achieved satisfactory efficacy.

Endoscopic characteristics, diagnosis and treatment of eosinophilic gastroenteritis (21 cases) / 中国内镜杂志

Objective To explore the clinical manifestation of eosinophilic gastroenteritis, reduce the misdiagnosis rate, then improve the clinical diagnosis and treatment rate. Methods The clinical data of patients with eosinophilic gastroenteritis diagnosed and treated by digestive medicine from 2008 to 2016 were analyzed and summarized retrospectively. Results The final diagnosis of 21 patients with no specific clinical manifestations were manifested as abdominal pain, diarrhea, abdominal distension, with nausea, vomiting, etc, respectively. Most of them have the history of asthma, skin and drug or food allergy history. The clinical type was mainly mucosa type, 16 cases, 3 case were serosa and 2 cases were mixed type. Peripheral blood neutrophil percentage and eosinophil proportion increased; Some patients with bone marrow results suggested the bone marrow hyperplasia was active, increased proportion of eosinophils. Eosinophils increased in ascites test. Abdominal CT can also be seen thickening of the intestinal wall, showing ascites. Hormone therapy to 19 patients was effective. Conclusion Eosinophilic gastroenteritis is a cureable disease. Because of its clinical manifestation, it is necessary to get more knowledge and attention from clinicians and pathologists to diagnosis and treatment as soon as possible to avoid misdiagnosis.

Diagnosis and treatment of eosinophilic gastroenteritis in children / 中华实用儿科临床杂志

Eosinophilic gastroenteritis is a relatively rare chronic gastrointestinal inflammatory disease in children,characterized by gastrointestinal eosinophil infiltration.Clinical manifestations due to infiltration of different sites and levels were diverse,endoscopic performance is often nonspecific,the diagnosis of eosinophilic gastroenteritis is mainly based on gastrointestinal symptoms,a large number of eosinophil histological infiltration,and exclude other diseases that cause eosinophil infiltration in gastrointestinal tissue.Treatments include diet therapy,glucocorticoids,anti-allergy drugs,immunomodulatory therapies.Although diet therapy and glucocorticoid treatment improve clinical symptoms in most children,long-term maintenance therapy and follow-up are often required to prevent recurrence.In children with serious complications,such as perforation and obstruction,may require surgery and other treatments.

The role of costimulatory molecule CD40 in childhood eosinophilic gastroenteritis and its mechanism / 临床儿科杂志

Objective To explore the dynamic changes and significance of costimulatory molecules CD40 and lymphocyte subsets in peripheral blood of children with eosinophilic gastroenteritis (EG). Methods The CD40 expression and lymphocyte subsets in peripheral blood were detected by flow cytometry (FCM) in 15 children with EG (acute stage and remission stage) and 15 healthy controls. The level of serum interleukin (IL) -4 was detected by enzyme-linked immunosorbent assay (ELISA). The eosinophil (EOS) was count by blood cell analyzer. Results In acute stage, the children with EG had significantly higher expression of CD40, CD3+, CD4+, CD4+/CD8+, and CD19+CD23+ in peripheral blood, higher serum IL-4 level, higher EOS count and lower CD8+ than in remission stage and control group (P all<0.05). There were no differences between remission stage and control group (P>0.05). In acute stage, the expression of CD40 in peripheral blood in children with EG was positively correlated with the expression of CD4+ and IL-4 (P all<0.05). Conclusions CD40 may be involved in the pathogenesis of EG. That the increase of IL-4 secreted by CD4+ T cells that were induced by CD40 results in abnormal increase of EOS may be one of mechanisms of the pathogenesis of EG.

Clinical and endoscopic features of pediatric eosinophilic gastroenteritis in 49 cases / 中华实用儿科临床杂志

Objective To explore the clinical features and endoscopic manifestations of eosinophilic gastroente-ritis(EG)in children.Methods A retrospective analysis was conducted of the clinical manifestation,laboratory examination,endoscopy(upper and/or colonoscopy)performance,diagnosis and treatment of 49 cases of patients who were diagnosed as EG in Children's Hospital of Nanjing Medical University from July 2013 to July 2015.Results The common clinical manifestations of EG in children were hematochezia(23 cases),diarrhea(20 cases),vomiting(18 cases)and abdominal pain(15 cases).The ages of children admitted to hospital for the first time ranged from 1 month and 7 days old to 13 years and 7 months old,and the mean age was 59.4 months old,in which most patients were younger than 1 year old,accounting for 38.77％(19 cases)of all.Peripheral blood eosinophilia was present in 20 cases(40.82％)of the patients,and only 6/18 cases(33.33％)of the patients had elevated serum IgE.Upon endoscopic analysis,the lesions involved esophagus(4 cases),stomach(14 cases),duodenum(20 cases),small intestine(15 cases),colon(28 cases)and rectum(6 cases),and the most common manifestation under gastroscopy was mucosal hyperemia edema(27 cases)and erosion(9 cases),while the most common manifestation under colonoscopy was mucosal hyperemia edema(25 cases)and nodular hyperplasia(24 cases).All patients improved with food restriction,in which 8 cases were treated with glucocorticoid while 9 cases with oral Singulair and 9 cases with oral Loratadine.All children with symptoms were alleviated somewhat,but 5 cases of them relapsed after drug withdrawal.Conclusions The clinical manifestations of EG in children varied and were mainly hematochezia,vomiting,diarrhea and abdominal pain.Some patients had the elevated peripheral blood eosinophilia and serum IgE.The most common manifestations under gastroscopy were mucosal hyperemia edema and erosion while the most common manifestations under colonoscopy were mucosal hyperemia edema and nodular hyperplasia.

The clinical, endoscopic and pathologic characteristics of eosinophilic gastroenteritis of 24 cases infants resulted from milk protein allergy / 中国内镜杂志

Objective By studying clinical features, treatment and prognosis of eosinophilic gastroenteritis of infants resulted from milk protein allergy an, to improve the diagnosis and treatment level of eosinophilic gastroenteritis. Methods 24 cases of infants which diagnosed eosinophilic gastroenteritis were chosen from June of 2010 to January of 2014 in children’s Hospital of XX province and By retrospective analysis clinical manifestations, endoscopic features, histopathology, treatment and prognosis of the 24 cases. Results The 24 cases who were vomiting, paroxysmal crying, abdominal distension (100.00%), which accompanied by haematemesis 23 cases (95.83%), 1case (4.17%) hematochezia, 17cases (70.83%) eczema, 21 cases (87.50%) mild to moderate anemia, 1 cases (4.17%) severe anemia, 19 cases (79.17%) the increasing of peripheral blood eosinophil cells, 8 cases (33.33%)the increasing of IgE of the serum and 4 cases (16.67%) the test of antibody of the Helicobacter pylori in Serum was positive; 3 cases (12.50%) were milk protein allergy by the detecting of food allergen-speciifc IgE antibodies, the endoscopic characteristics were hyperemia, edema, erosion, ulcer of gastric and duodenal mucosa. Among them, 24 cases (100.00%) were gastritis, 5 cases (20.83%) duodenitis and 1 cases (4.17%) duodenal ulcer. The histopathology of the 24 cases revealed that there were gastric or duodenal eosinophils infiltration (> 20/HPF) and were all associated with mast cell infiltration; By antisecretory, protection of the gastrointestinal mucosa and the obviating of milk protein had a satisfactory treatment effect, 24 cases of children with oral general formula milk test conifrmed that the milk protein allergy, The 3 cases of the patients were reviewed by 8~12 weeks after gastroscope, and the mucosa of the duodenum was smooth, Eosinophils were/HPF<8, mast cells were/HPF<5. Conclusion There are no speciifc clinical and endoscopic manifestations in eosinophilic gastroenteritis of infants resulted from milk protein allergy, gastrointestinal mucosa eosinophil inifltration and simultaneously are accompanied by abnormal mast cell inifltration;Mucosal type without the use of corticosteroids, through milk protein avoidance treatment can achieve satisfactory results, But definite diagnosis must rely on biopsy and eosinophils, combined with avoidance stimulation test of milk protein can further confirmed, But the excitation test should be at least 10 days of observation of children, and carefully recorded symptoms, so as not to delay the missed diagnosis of CMPA.