儿童嗜酸细胞性胃肠炎的诊治体会并文献复习

Diagnosis and treatment of eosinophilic gastroenteritis in children: A report of 10 cases and literature review

目的探讨儿童嗜酸细胞性胃肠炎(eosinophilic gastroenteritis,EG)的临床表现、诊断和治疗.方法回顾性分析2012-04/2016-04重庆医科大学附属儿童医院消化内科住院并确诊的10例E G患儿的临床表现、实验室检查、内镜检查及黏膜组织病理学、治疗及预后,并结合文献复习进行分析.结果10例患儿主要症状为腹痛4例(40%)、腹泻4例(40%)、腹胀2例(20%)、呕吐2例(20%,伴有呕血)、血便2例(20%)、浮肿2例(20%)等.9例(90%)外周血白细胞升高,7例(70%)血小板升高,9例(90%)嗜酸细胞显著升高,4例(40%)大便隐血阳性.腹部彩超:2例肝脏稍肿大,2例腹腔中量积液,1例胃潴留、肠腔淤胀.胃镜检查9例,结肠镜检查1例.胃镜下可见黏膜充血、水肿,伴点或片状糜烂、溃疡,部分黏膜覆薄白苔;结肠镜下可见黏膜充血水肿、红斑和浅表溃疡.病理学检查:发现黏膜较多嗜酸细胞浸润(均≥20个每高倍视野),2例患儿腹水发现大量嗜酸细胞.临床分型:黏膜病变型8例,浆膜病变型2例.给予饮食治疗(氨基酸配方奶粉)和/或药物治疗(糖皮质激素、白三烯受体拮抗剂、地氯雷他定等),均好转出院,9例无症状复发,1例因进食快餐食品后症状复发.结论儿童EG临床表现多样,绝大多数患儿外周血嗜酸细胞升高,内镜和黏膜组织病理学检查对EG的确诊有重要意义,饮食干预对部分儿童EG治疗有效,糖皮质激素治疗效果好.

AIM To investigate the clinical manifestations, diagnosis and treatment of eosinophilic gastroenteritis（EG） in children.METHODS We retrospectively analyzed 10 cases of EG diagnosed at the Department of Gastroenterology of Children＇s Hospital of Chongqing Medical University during the past 4 years（2014-04/2016-04） and reviewed the literature to summarize the characteristics of EG, including clinical manifestations, laboratory, endoscopic, and pathological findings, treatment strategy and prognosis.RESULTS Common symptoms were abdominal pain（40%）, diarrhea（40%）, abdominal distension（ 20 %）, vomiting（20%, accompanied by hematemesis）,bloody stool（20%）, and edema（20%）. Nine（90%） had an increased peripheral white blood cell count, 7（70%） had thrombocytosis, and 9（90%） had a signifi cantly increased peripheral eosinophil count. On abdominal color Doppler ultrasound, slight liver enlargement was observed in 2 cases, a small amount of ascites in 2 cases, and gastric retention and intestinal distension in 1 case. Gastroscopy was performed in 9 cases and colonoscopy in 1 case. Gastroscopy showed mucosal hyperemia, edema, spotty or patchy erosion and ulcer, and whitish coating in the stomach. Colonoscopy showed mucosal hyperemia, edema, erythema and superficial ulcer. Mucosal pathological examination showed marked mucosal eosinophil infiltration（more than 20 eosinophils per microscopic high-power field） in all cases, and a large number of eosinophils in ascites in 2 cases. Cases were classified as mucosal（n=8） and subserosal（n=2）. Dietary intervention（amino acid formula） and/or drug therapy（glucocorticoids, leukotriene receptor antagonist, desloratadine, etc.） were administered in the 10 cases. EG-related symptoms were alleviated in 9 cases without recurrence after discontinuation of the therapy. Only 1 case was recurrent after eating fast food.CONCLUSION Clinical manifestations of EG are diverse in children. The majority of patients have peripheral eosinophilia. Endoscopy and mucosal biopsy can provide diagnostic clues for EG. Dietary intervention is effective for the treatment of EG in some patients, while corticosteroid treatment remains the best therapy for EG.