Eosinophilic gastroenteritis
Introduction
Introduction to eosinophilic gastroenteritis Eosinophilic gastroenteritis (eosinophilic gastroenteritis) is a gastrointestinal disease characterized by peripheral blood eosinophilia. The stomach and small intestine have varying degrees of eosinophil infiltration, the cause is not clear, and allergic reactions, Related to immune dysfunction. Clinical manifestations of upper abdominal spasm pain, may be associated with nausea, vomiting, fever or special food allergies, good response to glucocorticoid therapy, young adults, and children are rare. basic knowledge The proportion of illness: 0.05% - 0.08% Susceptible people: good for young adults Mode of infection: non-infectious Complications: amenorrhea, intestinal obstruction, pyloric obstruction, achalasia, ascites
Cause
Causes of eosinophilic gastroenteritis
(1) Causes of the disease
The etiology of eosinophilic gastritis is not clear. It is generally thought to be caused by allergic reactions to exogenous or endogenous allergens. Nearly half of the patients have asthma, allergic rhinitis, eczema or urticaria history; some patients Symptoms can be induced by certain foods such as milk, eggs, lamb, shrimp or certain drugs such as sulfonamides, trifluralin and indomethacin; some patients have elevated levels of IgE in their blood after taking certain foods, and With the corresponding symptoms, the disease is considered to be related to special food allergies.
(two) pathogenesis
Eosinophilic gastroenteritis is characterized by eosinophil infiltration in tissues. It is believed that this disease is caused by certain substances to cause systemic or local allergic reactions. It is a syndrome secondary to unknown antigens and allergic reactions for some reason. It is generally considered to be degranulated by eosinophils, releasing various enzymes, causing tissue damage and causing disease. According to the disease, hormone therapy is effective, some patients have elevated blood IgE, have a history of allergies or family history, and propose type I allergic reactions. Hypothesis, it is believed that due to some factors, the integrity of the gastrointestinal mucosa is destroyed, food and other antigens enter the tissue, mast cells are sensitized and degranulated, and histamine eosinophil chemokines are released, causing eosinophil infiltration and Degranulation, causing tissue damage, the release of eosinophilic peroxidase further stimulates mast cells to release histamine, forming a vicious circle, except for type I allergic reactions, abnormal immune function in the pathogenesis of eosinophilic gastroenteritis Has occupied an important position, but has not found a consistent immune dysfunction, it has been suggested that eosinophilic gastroenteritis is a specific inflammation of the digestive tract This certain allergic eosinophilic inflammation is caused by an unknown antigen, as Crohn's disease, ulcerative colitis part, amoebic dysentery, milk protein colitis reaction.
It has been reported that eosinophilic enteritis has a genetic predisposition, and there is no final conclusion because of no familial investigation.
The affected parts can be from the esophagus to the rectum, and the small intestine and stomach are most common. The histological features are a large number of eosinophil infiltration, which can be aggregated into a heap. Eosinophil infiltration can affect the whole gastrointestinal wall, or a certain One layer is mainly affected, the most common are mucosa and submucosa, followed by muscle layer, serosal layer is rare, other pathological changes include edema, small intestine villi atrophy, mucosal and glandular epithelial cell necrosis and regeneration, eosinophil infiltration can be seen in Any inflammatory process, while other inflammatory cells are significantly increased, should be noted to identify with it.
Prevention
Eosinophilic gastroenteritis prevention
The disease is a self-limiting allergic disease, no effective preventive measures, early detection and early treatment is the key to the prevention and treatment of this disease.
Complication
Eosinophilic gastroenteritis complications Complications, amenorrhea, intestinal obstruction, pyloric obstruction, achalasia, ascites
Adolescent onset can lead to growth retardation, and can have amenorrhea. The typical clinical manifestations of myometrial involvement are intestinal obstruction or pyloric obstruction, and corresponding symptoms and signs appear. Occasionally, eosinophils infiltrate the esophageal muscle layer. Caused by achalasia, the least common to the involvement of the serosa layer, typical manifestations of ascites, a large number of eosinophils can be seen in the ascites.
Symptom
Eosinophilic gastroenteritis symptoms Common symptoms Nausea and vomiting edema The intestinal absorption of water increases diarrhea and abdominal pain
Eosinophilic gastroenteritis can occur at any age, with the highest incidence from 20 to 50 years old, no gender differences, lesions can invade the whole digestive tract mucosa from the esophagus to the colon, clinical signs and symptoms of eosinophilic gastroenteritis Depending on the depth of infiltration of the gastrointestinal wall and the presence or absence of lesions in the esophagus, small intestine, and colon, it can be clinically classified into three types.
1. Mucosal type (type I) lesions mainly invade gastrointestinal mucosa, common symptoms are nausea, vomiting, abdominal pain, diarrhea, weight loss and low back pain. Eating special allergic food can aggravate the symptoms, physical examination can find skin eczema, Measles, edema of the ankle and foot, etc., some patients may also show anemia due to gastrointestinal bleeding, small intestinal malabsorption, protein-losing enteropathy, anemia and other systemic manifestations, adolescent dysplasia, growth retardation, female There may be secondary amenorrhea.
2. Muscular layer type (type II) is mainly caused by myometrial lesions. Due to thickening and stiffness of the stomach and small intestine wall, the main clinical manifestations are complete or incomplete pyloric and small intestinal obstruction, nausea, vomiting, abdominal pain, and anti- Acid or anticholinergic drugs are difficult to relieve.
3. Serosal type (type III) subserosal lesions are mainly, relatively rare, accounting for about 10% of the entire eosinophilic gastroenteritis, ascites can occur, ascites contains a large number of eosinophils, this type can be alone Exist, it can coexist with other two types.
Examine
Examination of eosinophilic gastroenteritis
Laboratory inspection
1. Blood test 80% of patients have peripheral blood eosinophilia, mucosal and submucosal lesions and myometrial lesions in the main patients (1 ~ 2) × 109 / L, plasma cell lesions dominated, up to 8 ×109/L, there may be iron deficiency anemia, serum albumin decreased, blood IgE increased, and erythrocyte sedimentation rate increased.
2. Fecal examination of acid cell gastroenteritis The significance of fecal examination is to exclude intestinal parasite infections, some can be seen in Charcot-Leyden crystallization, it is routinely tested for occult blood positive, some patients have light Degree of steatorrhea, increased Cr-labeled albumin, increased alpha-antitrypsin clearance, and abnormal D-xylose absorption test.
Film degree exam
1. X-ray examination of eosinophilic gastroenteritis lack of specificity, X-ray barium meal can be seen mucosal edema, wrinkle widening, nodular filling defect, gastrointestinal wall thickening, stenosis and obstruction.
2. CT examination can find thickening of the gastrointestinal wall, mesenteric lymphadenopathy or ascites.
3. Endoscopy and biopsy are applicable to eosinophilic gastroenteritis with mucosal and submucosal lesions. Microscopic mucosal folds, congestion, edema, ulcers or nodules can be seen under the microscope. Biopsy confirmed a large number of eosinophils from pathology. Cell infiltration is valuable for diagnosis, but biopsy tissue is of little value to patients with predominant muscle and serosal involvement, sometimes confirmed by surgical pathology.
4. Patients with abdominal puncture and ascites must undergo diagnostic abdominal puncture. Ascites is exudative and contains a large number of eosinophils. It must be stained with ascites to distinguish eosinophils and neutrophils.
5. Laparoscopic laparoscopic lack of specific performance, lighter only peritoneal congestion, severe cases can be similar to peritoneal metastases, the significance of laparoscopy is the abdominal biopsy of abdominal mucosa, pathological diagnosis.
6. Surgical exploration is generally performed for suspected eosinophilic gastroenteritis without laparotomy, but surgery is performed when there is intestinal obstruction or pyloric obstruction or suspected tumor.
Diagnosis
Diagnosis and identification of eosinophilic gastroenteritis
diagnosis
The diagnosis was mainly based on clinical manifestations, blood, radiology and endoscopy plus pathological findings.
1. Talley standard
(1) There are gastrointestinal symptoms.
(2) Biopsy pathology shows eosinophil infiltration in one or more sites from the esophagus to the colon, or radiological colon abnormalities with peripheral eosinophilia.
(3) Diseases other than parasitic infections and eosinophilia other than the gastrointestinal tract, such as connective tissue disease, eosinophilia, Crohn's disease, lymphoma, primary amyloidosis, Menetrieri disease, and the like.
2. Leinbach standard
(1) Gastrointestinal symptoms and signs appear after eating special foods.
(2) Peripheral blood eosinophilia.
(3) Histology proves that the gastrointestinal tract has eosinophilia or infiltration.
Differential diagnosis
1. Patients with indigestion eosinophilic gastroenteritis may have abdominal pain, nausea, vomiting, abdominal distension and other symptoms of dyspepsia, but often lack specificity. For patients with dyspepsia, patients with peptic ulcer, reflux esophagus Inflammation, gastric cancer, chronic pancreatitis and other identification.
2. Intestinal obstruction can often occur in the intestinal layer of the intestinal obstruction. It should be noted that except for gastrointestinal tumors and intestinal vascular diseases.
3. Ascites is more common in serosal eosinophilic gastroenteritis, ascites routine and biochemical tests, ascites CEA test, ascites pathological examination is helpful for the diagnosis of the disease.
4. Eosinophilia is a systemic disease of unknown etiology. It can also affect the gastrointestinal tract, 60% involving the liver, 14% involving the gastrointestinal tract, and diffuse eosinophilic gastroenteritis. Outside the intestine, 50% often involve organs outside the gastrointestinal tract.
5. Intestinal parasitic infection can cause a variety of non-specific gastrointestinal system symptoms, as well as peripheral blood eosinophilia, repeated examination of fecal eggs can be identified.
6. Allergic diseases Bronchial asthma, allergic rhinitis, urticaria, in addition to peripheral blood eosinophils, each has its clinical manifestations.
7. Eosinophilic granuloma mainly occurs in the stomach, large and small intestine, and is a localized mass. Peripheral blood eosinophils generally do not rise. The pathological feature is that eosinophilic granuloma is mixed in the connective tissue matrix.
8. Rheumatic diseases Various vasculitis, such as allergic granulomatosis (Churg-Strauss syndrome) and nodular polyarteritis, other connective tissue diseases such as scleroderma, dermatomyositis and polymyositis Involved in the gastrointestinal tract, abdominal pain, indigestion and other symptoms, there may be varying degrees of peripheral blood eosinophilia, small intestinal mucosal biopsy is helpful in differential diagnosis.
