摘要目的 探讨嗜酸性粒细胞性胃肠炎(EG)患儿的临床表现、内镜及组织病理学特征.方法 76例确诊EG的患儿纳入回顾性研究,总结和分析临床表现、实验室及影像学检查结果、内镜及组织病理学检查结果、幽门螺杆菌感染情况、治疗方案及转归.结果 临床主要表现为反复腹痛(55.3%,42/76)、呕吐(39.5%,30/76)和便血(38.2%,29/76).34例(44.7%,34/76)存在外周血血红蛋白降低,9例(11.8%,9/76)嗜酸性粒细胞(EOS)计数增高,13例(17.1%,13/76)EOS百分比增高,32例(54.2%,32/59)血清总IgE增高,18例(36.7%,18/49)食物特异性IgE阳性,25例(32.9%,25/76)大便隐血试验阳性.51例行腹部超声检查,发现腹腔积液7例、盆腔积液4例和肠管节段性改变3例.76例均行内镜检查,黏膜充血水肿63例(82.9%),溃疡20例(26.3%),糜烂17例(22.4%),结节样隆起或增生11例(14.5%),正常9例(11.8%);黏膜病理主要表现为黏膜炎症,伴大量EOS浸润(≥20个/高倍视野).12例(15.8%,12/76)存在幽门螺杆菌感染.76例患儿经饮食回避、抗过敏、抑酸、白三烯受体拮抗剂、皮质类激素等综合治疗,临床症状缓解74例,有效率为97.4%.其中,饮食回避、抗过敏药、抑酸剂、白三烯受体拮抗剂治疗有效率为93.8%(61/65),皮质类激素治疗有效率为86.7%(13/15).结论 儿童EG的临床表现及内镜特征均缺乏特异性;诊断方面,血清总IgE增高及食物特异性IgE检测阳性可作为该病诊断的参考,最终确诊仍需黏膜病理检查(嗜酸性粒细胞浸润≥20个/高倍视野);治疗方面,抗过敏药、抑酸剂、白三烯受体拮抗剂对症治疗有效率高,可作首选方案,无需常规使用皮质激素治疗.

abstractsObjective To analyze the clinical, endoscopic and histopathological features of eosinophilic gastroenteritis ( EG) in children. Methods A retrospective study of 76 children with EG was performed to analyze clinical symptoms, laboratory and imaging results, endoscopic and pathological features, status of Helicobacter pylori ( H. pylori) infection, treatment and outcomes. Results The main clinical symptoms were abdominal pain in 55. 3%(42/76) cases, vomiting in 39. 5% (30/76) cases and hematochezia in 38. 2% cases( 29/76) . The hemoglobin level decreased significantly in 34 cases ( 44. 7%, 34/76). Peripheral blood eosinophil (EOS) count increased significantly in 9 cases (11. 8%,9/76) and EOS percentage increased significantly in 13 cases(17. 1%,13/76). Total serum IgE elevated in 32 cases ( 54. 2%, 32/59 ) . There were also 18 cases ( 36. 7%, 18/49 ) positive in serum allergen?specific immunoglobulin E ( sIgE) test and 25 cases ( 32. 9%,25/76) positive in fecal occult blood test. Among 51 cases of abdominal ultrasound examination, there were 7 cases of ascites, 4 cases of pelvis fluid and 3 cases of intestinal wall change. Endoscopic examination in 76 cases showed 63 cases ( 82. 9%) of mucosal hyperemia/edema,20 cases ( 26. 3%) of ulceration, 17 cases ( 22. 4%) of erosion, 11 cases ( 14. 5%) of nodularity or hyperplasia and 9 cases ( 11. 8%) of normal mucosa. The pathological examination showed mucosal inflammation with a large number of EOS infiltration(≥20 per HPF).There were 12 cases(15. 8%, 12/76) of H. pylori infection. Among the 76 cases, clinical symptoms improved significantly in 74 patients after treatment with dietary allergen avoidance, anti?allergy medications, antacids, montelukast and corticosteroid, and the total efficacy was 97. 4%. The efficacy of dietary allergen avoidance, anti?allergy medications, antacids and montelukast was 93. 8%( 61/65 ) . The efficacy of corticosteroid was 86. 7%(13/15). Conclusion The clinical manifestations and endoscopic characteristics of EG in children lack specificity. In terms of diagnosis, the elevated total serum IgE and the positive sIgE test may be taken as reference for the diagnosis of EG. The definite diagnosis is based on pathological examination ( EOS infiltration≥20 per HPF).While in terms of treatment, dietary allergen exclusion, anti?allergy medications, antacids and montelukast are highly effective, which can be taken as the first option. There is no need of corticosteroid as routine therapy.