误诊为黏膜下肿瘤的嗜酸性粒细胞性胃炎患者的临床特征及内镜特点分析

The clinical features and endoscopic features of eosinophilic gastritis which were misdiagnosed as sub mucosal tumor

目的探讨误诊为黏膜下肿瘤的嗜酸性粒细胞性胃炎(EG)患者的临床特征及内镜下表现,以有助于此类患者的诊断。方法对16例误诊为黏膜下肿瘤并行黏膜下剥离术(ESD)后病理诊断为嗜酸性粒细胞性胃炎患者的临床表现、实验室结果和内镜特点进行分析。结果 16例患者平均年龄为(51.56±11.48)岁,男女比例为4∶12,7例有药物过敏史,无明显食物过敏史。临床表现以腹痛、腹胀、恶心、呕吐、反酸、嗳气等消化不良症状为主,多数患者病程超过1年,且反复发作。周围血嗜酸细胞升高者仅2例,占12.5%。16例病例内镜下均表现为胃窦部黏膜隆起,表面光滑或者有轻度糜烂。超声胃镜下有14例表现为黏膜层、黏膜肌层或黏膜下层的低回声病变,2例黏膜下层混合回声病变,所有病例行ESD术后病理结果均提示胃窦黏膜嗜酸性粒细胞浸润(>15~20/Hp)。结论胃镜下表现为黏膜隆起的嗜酸性粒细胞性胃炎症状无特异性,外周血嗜酸性粒细胞数目大多无升高,诊断仅能依靠病理结合临床症状。若此类患者能在超声胃镜下取足够深度的黏膜活检或许能避免行ESD术。

Objective To evaluate the clinical features and endoscopic features of eosinophilic gastritis(EG)which were misdiagnosed as sub mucosaltumor to contribute for the diagnosis of these patients.Methods16cases which were misdiagnosed as sub mucosal tumor performed Endoscopic Sub mucosalDissection(ESD),then was diagnosed eosinophilic gastritis,their clinical features,laboratory results and endoscopic features were analyzed.Results16casesof patients with an average age of(51.56±11.48)years old,male to female ratio was4/12,7cases had history of drug allergy,no significant food allergies.Clinical manifestations mainly for indigestion,such as abdominal pain/abdominal distention/nausea/vomiting/sour regurgitation and belching,the course ofmost patients lasts more than1year,and recurrent.Only2cases with peripheral blood eosinophilia cells increased,accounting for12.5%(2/16).16casesof endoscopic performance for the distal mucosal uplift,smooth surface or had mild erosion.Endoscopic ultrasonography(EUS)shows14cases of hypo echoiclesion from mucosal layer,muscularis mucosal layer and sub mucous layer,2cases of hybrid echo lesion from sub mucous layer.All cases had ESD,andpathologic results suggests that gastric antrum mucosa eosinophil infiltration(>15～20/HP).Conclusion There are no specific clinical symptoms of EGwhich were show sub mucosal tumors under the gastroscopy,the number of peripheral blood eosinophilia myelogenous almost no increase,diagnosis can onlyrely on the pathological combining with clinical symptoms.If these patients can take enough depth of mucous biopsy under ultrasound gastroscopy,maybe theywere able to avoid ESD.