嗜酸细胞性胃肠炎 临床表现和形态特征一项基于42例患者的回顾性研究课件.ppt

1、目录目录嗜酸细胞性胃肠炎嗜酸细胞性胃肠炎:临床表现和形态特临床表现和形态特征征-一项基于一项基于42例患者的回顾性研究例患者的回顾性研究目录目录简介简介n嗜酸性粒细胞相关的胃肠道疾病(EGIDs),包括嗜酸性粒细胞性食管炎(EE)和嗜酸性粒细胞性胃肠炎(EGE)，是一组炎性疾病，正越来越收到重视，以胃肠道嗜酸性粒细胞浸润以及伴有不同程度的胃肠道症状为特征。目录目录简介简介n本病有各种各样的临床表现：从需要手术治疗的情况到长期反复腹部不适。n内镜和影像学结果可能会正常或略有异常，部分病例可能会呈现弥漫性异常。n在某些情况下,很难获得组织学标本,因此在临床实践中，误诊或漏诊的情况很多。目录目录研究

2、目的研究目的n评估嗜酸细胞性胃肠炎在成人患者中的临床表现、内镜和影响学特征、组织学特性,和治疗。目录目录研究方法研究方法n本研究回顾和分析了明确诊断为嗜酸性胃肠炎的34位患者和有腹部症状和原因不明的外周嗜酸性粒细胞增多，但没有证据表明嗜酸性粒细胞组织渗浸润的8位患者的临床记录。目录目录研究结果研究结果n13名患者有哮喘或过敏性鼻炎,而10名患者有过敏史。外周嗜酸性粒细胞增多发生在83.3%的患者，IgE升高发生在50%的患者,2-巨球蛋白升高发生在92.8%的病人。n病变最长累及小肠(82.4%)。红斑是最常见的内镜下特征。影像学检查通常显示小肠壁的增厚。目录目录研究结果研究结果n嗜酸性粒细胞

3、增多通常累及粘膜固有层,但胃肠道各层都可能会受到影响,甚至可以发生在内镜或影像学外观正常的部位。n总之,15.4%(6/39)的患者有幽门螺杆菌感染。n有80%(20/25)的患者在应用类固醇激素治疗一周内症状缓解，58.8%(10/17)的患者给予对症治疗一周内症状缓解。目录目录研究结果研究结果n在类固醇激素治疗组,有85.7%(18/21)的患者在2周内嗜酸性粒细胞计数恢复正常,但在另一组没有没有1例(0/13)嗜酸性粒细胞计数2周内恢复正常。目录目录结论结论n嗜酸细胞性胃肠炎可能比以前认为的更常见。于十二指肠降段外观正常和异常的部位多次活组织检查是高度推荐的。类固醇激素治疗可以有效缓解症

4、状和改善嗜酸性粒细胞增多。目录目录Eosinophilicgastroenteritis:clinicalmanifestationsandmorphologicalcharacteristics,aretrospectivestudyof42patients目录目录IntroductionIntroductionnEosinophil associated gastrointestinal disorders(EGIDs),including eosinophilic esophagitis(EE)and eosinophilic gastroenteritis(EGE),are a spe

5、ctrum of inflammatory diseases which are recognized with increasing frequency,characterized by eosinophilic infiltration of the gastrointestinal(GI)tract with varying GI symptoms.目录目录IntroductionIntroductionnThere are various clinical manifestations associated with this disease which range from cond

6、itions requiring surgery to remitting discomfort over long periods.nEndoscopic and radiographic findings may vary from normal to slightly abnormal and cases may show diffuse abnormalities.目录目录IntroductionIntroductionnIn some cases,histological specimens are difficult to obtain,and as a result there

7、are many instances of misdiagnosis or missed diagnosis of EGE in clinical practice.目录目录OBJECTIVEOBJECTIVEnTo evaluate the clinical manifestations,endoscopic,and radiological characteristics,histological features,and treatment of eosinophilicgastroenteritis in adult patients.目录目录METHODSMETHODSnThe cl

8、inical records of 34 patients diagnosed as eosinophilic gastroenteritis and eight patients who had abdominal symptoms and unexplained peripheral eosinophilia but no evidence of tissue eosinophilic infiltration were reviewed and analyzed.目录目录RESULTSRESULTS1.Thirteenpatientshadahistoryofasthmaorallerg

9、icrhinitis,while10hadanallergichistory.2.Peripheraleosinophiliaoccurredin83.3%ofpatients,IgEwaselevatedinhalf,and2-macroglobulinwaselevatedin92.8%ofpatients.3.Thesmallintestine(82.4%)wasthemostcommonsiteinvolved.目录目录RESULTSRESULTS4.Erythemawasthepredominatefeatureseenonendoscopy.5.Radiographicstudyg

10、enerallyrevealedthickeningofthesmallintestinalwall.6.Eosinophiliagenerallyinvolvedthelaminapropriaofmucosa,butanylayerofthegutcouldbeaffected,eveninsiteswhichhadnormalendoscopicorradiographicappearance.目录目录RESULTSRESULTS7.Inall,15.4%(6/39)ofpatientshadHelicobacterpyloriinfection.8.Symptomremissionwi

11、thin1weekwasfoundin80%(20/25)ofpatientstreatedwithsteroidsandin58.8%(10/17)ofpatientstreatedwithsymptomatictreatment.9.Inall,85.7%(18/21)ofpatientshadtheireosinophilcountsreturntonormalwithin2weeksinthesteroidtreatmentgroup,butnone(0/13)intheothergroup.目录目录CONCLUSIONCONCLUSIONnEosinophilicgastroente

12、ritismaybemorecommonthanpreviouslyrecognized.nMultiplebiopsiesobtainedfromthebothnormalandabnormalappearingareasinthesecondpartoftheduodenumarehighlyrecommended.nSteroidsareeffectiveinrelievingsymptomsandimprovingeosinophilia.目录目录Zhang L,Duan L,Ding S,Lu J,Jin Z,Cui R,McNutt M,Wang A.Eosinophilic gastroenteritis:clinical manifestations and morphologicalcharacteristics,a retrospective study of 42 patients.Scand J Gastroenterol.2011 Sep;46(9):1074-80.目录目录Thanks for your attention!