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Key words cell gastroenteritisReported the following history: The patient, male, 35 years old, 5 years because of recurrent upper abdominal pain, recurrent hospitalization increased 1 week. 4 to 5 months each episode, after the summer relief, abdominal cramps were like, eating heavier, frequent vomiting, stomach food, no Sushi taste, exclusive yellow loose stools, no fever, and relieve itself of about half an hour, intermittently around 2h another attack, at the local with the mucosal protective agent, cimetidine, San Jiu Wei Tai ,654-2, de-worming and other treatment not effective. Physical examination: T 36.8 , P 78 times / min, R 18 times / min, BP 124/78mmHg, weight loss, combined with membrane slightly pale, soft abdomen, upper abdomen, deep tenderness without muscle guard and rebound tenderness, bowel sounds 12 times / min, more than the whole body revealed no abnormalities. Secondary examination: WBC 0.8 109 / L, N 66.6%, L 21.4%, E 11.2%, RBC 4.00 1012 / L, Hb 138g / L, PLT 286 109 / L, eosinophil count of 1.4 109 directly / L, blood AMS 86U / L (enzyme coupling method), stool: yellow loose stools, Ascaris eggs 0 / HP, urine routine (-), chest and abdomen together through: a little plot in the upper abdomen shows signs gas effusion , B-: the liver and spleen pancreas normal shape and size of gallbladder and bile duct without expansion, endoscopy: gastric mucosal edema, congestion and swelling pylorus. Colonoscopy: a high degree of congestion and edema


in the middle of transverse colon luminal narrow, the body still capable of lens through the remaining paragraphs were normal. Gastroscopy biopsy were suggestive of a large number of eosinophil infiltration. Double contrast barium small bowel no abnormal signs. Abdominal CT: Pancreatic shape and size of the spleen and kidney were normal, no retroperitoneal lymph nodes. Diagnosis is not clear, drew discussion.After the reception I have considered: (1) acute exacerbation of chronic gastritis, but the history of the gastric mucosal protective agents and antispasmodic agent used are not valid; (2), biliary disease, but the tenderness in patients with no fixed points, Morphy's sign (- ), B ultrasound and CT were excluded biliary problems; (3) abdominal allergic purpura (Henoch-type), and some abdominal pain allergic purpura may occur in purpura ago, but more common in children 1 to 2 weeks prior to the onset with general malaise, fever, fatigue and upper respiratory tract infection symptoms, skin purpura will appear eventually, the disease can be ruled out.You consider the gallbladder ascariasis, abdominal allergic purpura are increased eosinophils, are all secondary to peripheral blood eosinophil cell histiocytosis, also seen in infectious diseases, skin diseases, chemotherapy factor, He Jie Golden disease, cystic echinococcosis cysts rupture, the clinical and laboratory examination to exclude the disease.
Idiopathic syndrome of peripheral blood eosinophil absolute eosinophil count exceeds 1.5 109 / L [1], continuing more than six months, accompanied by the heart, brain, kidney, lung and skin and other multi-system, multi-organ involvement , involving the gastrointestinal tract, gastrointestinal tract when extensive infiltration of eosinophils, major organs were severely affected with poor prognosis. Recurrent in this case 5 years, longer duration, the general condition is good, no obvious heart, brain, kidney, lung and skin damage, so you can rule out the disease.
Ulcerative colitis and Crohn disease sometimes have blood eosinophilia, part of the existence of ulcerative colitis lesions eosinophilia [2], primarily a special performance with endoscopic and clinical features for diagnosis. The patients had nausea, vomiting, abdominal pain, diarrhea, gastrointestinal mucosa, especially gastroscopy showed edema, bowel wall thickening, expressed as gastritis and colitis, the peripheral blood eosinophilia, suggesting that eosinophilic gastroenteritis, and Crohn disease should be identified, no intestinal fistula, a narrow mouth existence and no secondary inflammation, arthritis, Crohn disease can be excluded.Eosinophilic gastroenteritis is not mentioned in textbooks in general, if you can explain to us?Eosinophilic gastritis (eosinophilic gastriesi) is a rare disease of unknown cause, may be allergic or immunological mechanisms involved in [3]. Lesions often in the gastric antrum, and proximal small intestine, said violations of eosinophilic gastroenteritis. Classification by Ureless two types, type is broad-based eosinophil infiltration in gastritis (referred to as eosinophilic gastroenteritis), type is limited eosinophil infiltration of granulomas (referred to as eosinophilic granuloma).
On the clinical manifestations of abdominal pain, nausea, vomiting, lack of specificity, the majority of eosinophils in peripheral blood increased, mainly to mucosal lesions and patients with muscle disease based absolute eosinophil count was (1 2) 109 / L, the serosal-based lesions, the average is 8 109 / L. Often accompanied by iron deficiency anemia, fecal occult blood more positive, showing that a large number of Charcot-Leyden crystals, and ESR, decreased serum albumin, serum IgE, IgG increased.
Endoscopic mucosal folds of type shows thick, congestion, edema, erosion, bleeding, or proliferation, proliferation at the biopsy of a large number of eosinophil, with diagnostic value [4]. Type mucosal congestion, edema, polypoid bulge if, should the tumor, Crohn disease and other identification.Yes, eosinophilic gastritis in 1937 by the kaijser first reported, the disease is rare in the clinic, there are special cases of the statistics of the world's only 300 cases reported in recent years with the inspection means and awareness level, the volume of coverage has increased, addicted type more common in acidic gastroenteritis 30 to 50 years of age, disease duration was chronic, recurring seizures, and spontaneous remission, but symptoms persist in some patients, the longest duration of up to 32 years [5]. 80% have gastrointestinal symptoms in the upper abdominal cramps pain, with nausea, vomiting, diarrhea and other symptoms, half of the patients may have other allergic disorders, such as allergic rhinitis and asthma. Mucosal involvement can cause serious gastrointestinal bleeding, diarrhea, malabsorption, intestinal protein loss, iron deficiency, and weight loss. Muscle involvement can cause significant pyloric obstruction or intestinal obstruction, and the emergence of the corresponding signs and symptoms are sometimes misdiagnosed as Crohn disease or tumor, serosal involvement may have a large number of eosinophils with ascites (called eosinophilic ascites) or pleural effusion occurs [6]. Generally exudative ascites. The patients met the above characteristics, is type. Type more common 40 to 60 years, the history of this type of stomach longer, acute onset, may have upper abdominal pain with cramps, nausea, vomiting. Combined peptic ulcer were more common, large ulcers, usually in 3cm or more in diameter, were located in the antrum and irregular [7].Eosinophilic gastroenteritis with no clear diagnostic standards?Leinbach currently used diagnostic criteria: (1) peripheral blood eosinophilia; (2) after exposure to allergens causes gastrointestinal symptoms and signs appear; (3) found in the gastrointestinal tract tissue eosinophilia or infiltration. Tailey standards can be applied [8]. Gastrointestinal manifestations of this disease is not specific, it is past history of allergies, peripheral blood (ascites or biopsy) eosinophilia is very important, with the gastrointestinal tract X-ray barium meal, endoscopic diagnosis can be made. Early diagnosis, where there are unexplained gastrointestinal symptoms, personal or family history of allergic disorders, or for food, drug-induced gastrointestinal symptoms and signs of increase, while those of peripheral blood eosinophilia should be considered of the disease possible. Eosinophils found in blood cells increased, endoscopy lesion was edema, biopsy specimens are more and more pieces of eosinophils, avoid with allergens, treatment with corticosteroids can relieve symptoms when may consider the diagnosis of eosinophilic gastroenteritis.Teachers, eosinophilic gastroenteritis treated?Principle of treatment of this disease is to remove allergens, inhibition of allergic reactions. First, actively search for and eliminate allergens substances. Mainly on the mucosal lesions were excluded from the relevant allergenic food or drugs, rapid improvement in abdominal pain and diarrhea. Second, the use of adrenal cortex hormones. Adrenal cortex hormones have good therapeutic effect, can in remission, most patients 1 to 2 weeks after treatment the symptoms improved, relapse medication still valid. For diffuse, mainly after surgery in patients with recurrence and ascites. Acute phase can be given prednisone 30 ~ 40mg, day 1, application 2 weeks, gradually reducing effective to maintain a daily dose of 5 ~ 10mg, for 2 to 4 weeks. Medication should pay attention to changes in blood. Third is the choice of disodium cromoglycate. Disodium cromoglycate (Dinatrii Cromoglycas) Department of mast cell membrane stabilizer, can stabilize mast cell membrane, inhibit the degranulation reaction, to prevent histamine, slow reactive substances and other media, and bradykinin release and thus to its anti-allergic effects. Adrenal cortex hormones on the clinical treatment fails, or have a more serious side effects may change using this treatment, usage: 40 ~ 60mg, 3 times a day treatment for 6 weeks to 5 months. Fourth, surgical treatment. Surgical treatment of unresectable by the infiltration of the site, mucosal edema, gastrointestinal anastomosis gave cause difficulties, easy to relapse after surgery. Therefore, since glucocorticoid use, eosinophilic gastroenteritis has been no surgery. Gastric eosinophilic granuloma intestinal obstruction occurs, medical treatment, surgery may be considered invalid. Under the circumstances, can be applied after a small dose of prednisone, 2.5mg or 5mg daily orally, for some time.1 Wang Jian, Zhu Feng, Jia-Ming Qian. Eosinophilic gastroenteritis with high eosinophilic syndrome. Chinese Journal of Digestion, 2003,23 (8): 45
Chen Hao Zhu 2. Practice of internal medicine. Eleventh edition. Beijing: People's Medical Publishing House, 2002,218
3 Guo-Ming Xu, Li Shi. Modern gastroenterology. Beijing: People's Medical Publishing House, 1999,70
4 Wang Weizheng, He Changhua. Chronic eosinophilic gastroenteritis involving the entire layer of the gastrointestinal wall in 1 case report. Chinese Journal of Medical Research, 2004,4 (2): 17
5 at all levels, Shen Zhixiang, Luo, and students. Practical gastroenterology. Beijing: Science Press, 1999,25
6 Liu Wenbin, Zhang Yu. A case of eosinophilic gastroenteritis and ascites. Clinical Internal Medicine, 2004,21 (9): 61
7 Huang new, Ru-Han Jia. Medical disease diagnosis and differential diagnostics. Wuhan: Hubei Science and Technology Press ,2001,514-51
8 Yang Di, Chang Xiao-Yan, Jiang Hong, et al. Eosinophilic gastroenteritis clinicopathological analysis of 9 cases. Diagnostic Pathology, 2004, l1 (2): 9
,400 Lichuan, Icheon City People's Hospital Department of Gastroenterology


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