嗜酸细胞性胃肠炎临床表现及病理学形态特征分析课件.ppt

1、目录目录嗜酸细胞性胃肠炎的临床表现及病理学嗜酸细胞性胃肠炎的临床表现及病理学形态特征分析形态特征分析目录目录简介简介n嗜酸细胞性胃肠炎（EG）是一种少见胃肠道疾病。KLEIN 等人按嗜酸细胞浸润程度及部位提出该病分型，OYAIZU 等提出过敏机制。TALLEY 等人总结分析拟出嗜酸细胞性胃肠炎的诊断标准，现被广泛采用。目录目录嗜酸细胞性胃肠炎嗜酸细胞性胃肠炎36 例临床分析例临床分析研究一研究一目录目录研究目的研究目的n探讨嗜酸细胞性胃肠炎的临床特征及诊断方法。目录目录研究方法研究方法n收集北京大学第三医院消化内科19952008年收治的嗜酸细胞性胃肠炎患者36例，对其一般情况、临床症状、实验

2、室检查、消化道造影、内镜及病理表现和治疗随访等情况进行系统性回顾分析、总结。目录目录研究结果研究结果n嗜酸细胞性胃肠炎多呈急性或亚急性病程,多有过敏性疾病病史或饮食的诱发因素。n症状以腹痛、腹泻、恶心呕吐为主,无肠外症状。n多数患者外周血嗜酸细胞计数升高。目录目录研究结果研究结果n内镜下主要为炎性改变,活检部位以小肠特别是十二指肠检出率较高,病理示胃肠道组织以大量嗜酸细胞为主的炎性细胞浸润,其中统计小肠嗜酸细胞38/HP。n治疗首选皮质激素,抗过敏、饮食调整有效。目录目录目录目录结论结论n临床怀疑嗜酸细胞性胃肠炎时应在内镜或造影检查时行多部位活检，即使内镜和造影观察正常,也应进行黏膜活检，十二

3、指肠是活检的关键部位，空肠活检亦能提高其诊断率。目录目录蔡召强蔡召强,王爱英王爱英,吕愈敏吕愈敏.嗜酸细胞性胃肠炎嗜酸细胞性胃肠炎36例临床分析例临床分析J.中国内镜杂志中国内镜杂志,2010,02:135-139.目录目录Eosinophilic gastroenteritis:clinical manifestations and morphological characteristics,a retrospective study of 42 patientsStudy Two目录目录IntroductionIntroductionnEosinophil associated gastr

4、ointestinal disorders(EGIDs),including eosinophilic esophagitis(EE)and eosinophilic gastroenteritis(EGE),are a spectrum 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Int

5、roductionIntroductionnThere are various clinical manifestations associated with this disease which range from conditions requiring surgery to remitting discomfort over long periods.nEndoscopic and radiographic findings may vary from normal to slightly abnormal and cases may show diffuse abnormalitie

6、s.目录目录IntroductionIntroductionnIn some cases,histological specimens are difficult to obtain,and as a result there 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 characterist

7、ics,histological features,and treatment of eosinophilicgastroenteritis in adult patients.目录目录METHODSMETHODSnThe clinical records of 34 patients diagnosed as eosinophilic gastroenteritis and eight patients who had abdominal symptoms and unexplained peripheral eosinophilia but no evidence of tissue eo

8、sinophilic infiltration were reviewed and analyzed.目录目录RESULTSRESULTS1.Thirteenpatientshadahistoryofasthmaorallergicrhinitis,while10hadanallergichistory.2.Peripheraleosinophiliaoccurredin83.3%ofpatients,IgEwaselevatedinhalf,and2-macroglobulinwaselevatedin92.8%ofpatients.3.Thesmallintestine(82.4%)was

9、themostcommonsiteinvolved.目录目录RESULTSRESULTS4.Erythemawasthepredominatefeatureseenonendoscopy.5.Radiographicstudygenerallyrevealedthickeningofthesmallintestinalwall.6.Eosinophiliagenerallyinvolvedthelaminapropriaofmucosa,butanylayerofthegutcouldbeaffected,eveninsiteswhichhadnormalendoscopicorradiogr

10、aphicappearance.目录目录RESULTSRESULTS7.Inall,15.4%(6/39)ofpatientshadHelicobacterpyloriinfection.8.Symptomremissionwithin1weekwasfoundin80%(20/25)ofpatientstreatedwithsteroidsandin58.8%(10/17)ofpatientstreatedwithsymptomatictreatment.9.Inall,85.7%(18/21)ofpatientshadtheireosinophilcountsreturntonormalw

11、ithin2weeksinthesteroidtreatmentgroup,butnone(0/13)intheothergroup.目录目录目录目录目录目录目录目录目录目录CONCLUSIONCONCLUSIONnEosinophilicgastroenteritismaybemorecommonthanpreviouslyrecognized.nMultiplebiopsiesobtainedfromthebothnormalandabnormalappearingareasinthesecondpartoftheduodenumarehighlyrecommended.nSteroids

12、areeffectiveinrelievingsymptomsandimprovingeosinophilia.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!