The disease usually involves the gastric sinus and proximal jejunum, and if the colon is involved, it is more common in the cecum and ascending colon. In addition, it can also involve the esophagus, liver and biliary system, causing eosinophilic esophagitis, hepatitis and cholecystitis, and there are also reports of involvement of the rectum only.
Blood tests: 80% of patients have peripheral blood eosinophilia, 1~2)×109/L in patients with predominantly mucosal and submucosal lesions and myelopathy, and up to 8×109/L in patients with predominantly plasma cell lesions. iron deficiency anemia, decreased serum albumin, increased blood IgE, and increased sedimentation may also be present.
The significance of fecal examination in acid cell gastroenteritis is to exclude intestinal parasitic infections, some may see Charcot-Leyden crystals, positive occult blood in routine stool examination, some patients have mild to moderate steatorrhea. increased Cr-labeled albumin, increased clearance of alpha-antitrypsin, abnormal D-xylose absorption test.
Other ancillary examinations 1, X-ray examination: eosinophilic gastroenteritis lacks specificity. Barium X-ray meal reveals mucosal edema, widening of folds, nodular filling defects, thickening of the gastrointestinal wall, luminal narrowing and obstruction.
2.CT examination: thickening of the gastrointestinal wall, enlarged mesenteric lymph nodes or ascites can be found.
3, endoscopy and biopsy: for eosinophilic gastroenteritis in which mucosal and submucosal lesions are predominant. Microscopically, coarse mucosal folds, congestion, edema, ulcers or nodules are seen, and biopsy is pathologically confirmed to have a large number of eosinophil infiltrates, which is valuable for confirming the diagnosis. However, the biopsy tissue is of little value for patients with predominantly muscular and plasma layer involvement, and sometimes requires surgical pathological confirmation.
4, laparotomy: patients with ascites must perform diagnostic laparotomy, ascites is exudative, containing a large number of eosinophils, must do staining of ascites smear to distinguish between eosinophils and neutrophils.
5.Laparoscopy: laparoscopy lacks specific manifestations, and in mild cases, there is only peritoneal congestion, and in severe cases, it may resemble peritoneal metastatic cancer. The significance of laparoscopy is to perform biopsy of peritoneal mucosal tissue and get pathological diagnosis.
6.Surgical exploration: for suspected eosinophilic gastroenteritis generally not dissection to confirm, but when there is intestinal obstruction or pyloric obstruction or suspicion of tumor then surgery is performed.
Treatment The principle of treatment for this disease is to remove allergens, inhibit allergic reactions and stabilize mast cells to achieve symptom relief and clear lesions.
1, the application of glucocorticoids: hormones have good efficacy on the disease, most cases in 1 to 2 weeks after the use of drugs, the symptoms will improve, manifested as the rapid elimination of abdominal spasmodic pain, diarrhea reduced and disappeared, peripheral blood eosinophils decreased to normal levels. In patients with plasma membrane type with ascites as the main manifestation, ascites disappeared completely 7-10 days after hormone application. The long-term outcome is also very good. In individual cases where hormonal therapy does not completely eliminate the symptoms, the addition of azathioprine is often effective (50-100 mg daily). Generally, prednisone 20-40mg/d orally for 7-14 days is used as a course of treatment. Comparable doses of dexamethasone may also be applied.
2, the application of disodium cromoglycate: disodium cromoglycate (sodium cromoglycate) is a mast cell stabilizer, can stabilize the mast cell membrane, inhibit its degranulation reaction, prevent the release of histamine, slow-reacting substances and bradykinin and other mediators and play its anti-allergic effect. The usage of disodium cromoglycate is 40-60mg 3 times daily. It is also used up to 800-1200 mg/d. The duration of treatment varies from 6 weeks to 5 months. Disodium cromoglycate can be used as an alternative to glucocorticosteroid therapy for those who are ineffective or have more serious side effects.
3.Surgical treatment: Patients whose lesions are limited to myxomatous infiltration, often with pyloric obstruction or small intestinal obstruction, can be considered for subtotal gastrectomy or intestinal segment resection or gastrointestinal anastomosis. If there are still symptoms or elevated eosinophils after surgery, small doses of prednisone can still be applied, 5mg or 2.5mg/d orally, to maintain treatment for a period of time.