PDF herunterladen
Z Gastroenterol 2013; 51(7): 638-642
DOI: 10.1055/s-0033-1335326
Kasuistik
© Georg Thieme Verlag KG Stuttgart · New York

Clinical Features of Eosinophilic Gastroenteritis with Ascites

Klinische Präsentation der eosinophilen Gastritis mit Aszites
L. Liu
1   Gastroenterology, Nanhai Hospital, Southern Medical University, Foshan
,
X. Y. Liang
1   Gastroenterology, Nanhai Hospital, Southern Medical University, Foshan
,
H. He
2   Obstetrics and Gynecology, Nanhai Hospital, Southern Medical University, Foshan
,
H. Huang
1   Gastroenterology, Nanhai Hospital, Southern Medical University, Foshan
,
L. P. Jia
1   Gastroenterology, Nanhai Hospital, Southern Medical University, Foshan
› Institutsangaben
Weitere Informationen

Publikationsverlauf

13. November 2012

16. März 2013

Publikationsdatum:
09. Juli 2013 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Objective: The aim of this study was to evaluate the clinical features and treatment responses of eosinophilic gastroenteritis (EG) with ascites.

Methods: Clinical data were collected on 6 EG patients with ascites from 2000 to 2012.

Results: Six patients were included in this study, ranging in age from 15 to 30 years. Most had an acute onset (5/6). The clinical manifestations included abdominal pain (5/6), vomiting (4/6), and diarrhea (3/6). The absolute values and percentages of peripheral blood eosinophils (Eos) were significantly elevated in all patients. Erosive or ulcerative lesions were found on endoscopic examination of all patients (6/6). Eosinophilic inflitration was confirmed by endoscopic biopsies (4/6). Ultrasound or abdominal CT showed gastrointestinal wall thickening and peritoneal effusion (6/6). Ascites from the patients were analyzed. Eos were found in ascites by pathological examination in the majority (5/6). The symptoms and peripheral eosinophilia responded to glucocorticoid treatment (p < 0.05). All the patients had good outcomes. One female patient had a relapse, which responded to re-administration of glucocorticoid treatment.

Conclusions: EG with ascites is more common in young patients, often presenting with non-specific symptoms. Typical clinical manifestations include acute onset, abdominal pain, and ascites. Eos in ascites and peripheral blood are the main diagnostic clues. Ultrasound and CT examinations are important to support the diagnosis of EG, and endoscopic biopsies can help to establish the diagnosis. Treatment with glucocorticoids is effective.

Zusammenfassung

Ziel: Evaluierung der klinischen Präsentation und Behandlungsergebnisse bei eosinophiler Gastroenteritis (EG) mit begleitendem Aszites.

Methoden: Von 2000 bis 2012 wurden klinische Daten von 6 EG-Patienten mit Aszites gesammelt.

Ergebnisse: Sechs Patienten im Alter von 15 - 30 Jahren wurden in die Studie eingeschlossen. Bei den meisten Patienten (5/6) traten die Symptome akut auf. Klinisch manifestierten sich abdominelle Schmerzen (5/6), Erbrechen (4/6), und Diarrhöe (3/6). Bei allen Patienten waren die absoluten und prozentualen Werte der peripheren Eosinophilen in Blut (Eos) signifikant erhöht. Die endoskopische Untersuchung ergab bei allen Patienten (6/6) erosive oder ulzerative Läsionen. Die endoskopische Biopsie bestätigte die Infiltration mit Eosinophilen (4/6). Eine Sonografie oder CT des Abdomens zeigte eine Wandverdickung im Magen-Darm-Trakt und peritoneale Flüssigkeitsansammlungen (6/6). Aszites der Patienten wurde untersucht. Die pathologische Untersuchung zeigte bei der Mehrheit der Patienten (5/6) das Vorhandensein von Eosinophilen. Die klinischen Symptome sowie die periphere Eosinophilie sprachen auf die Behandlung mit Glukokortikoiden an (p < 0,05). Alle Patienten zeigten ein gutes Behandlungsergebnis. Eine Patientin erlitt einen Rückfall, der jedoch auf erneute Gabe von Glukokortikoiden ansprach.

Schlussfolgerungen: EG mit Aszites tritt bei jungen Patienten häufiger auf, oft mit unspezifischen Symptomen. Typische klinische Manifestationen sind akutes Auftreten der Symptome, abdominelle Schmerzen und Aszites. Das Vorhandensein von Eosinophilen in Aszites und peripherem Blut sind die wesentlichen dignostischen Hinweise. Sonografie und CT Untersuchungen sind wichtig, um die Diagnose der EG zu stützen und eine endoskopische Biopsie kann bei der Diagnosestellung hilfreich sein. Die Behandlung mit Glukokortikoiden hat sich als wirksam erwiesen.

Key words

gastritis - infectious colitis - maldigestion - eosinophilic gastroenteritis - ascites - pathology - glucocorticoids

Schlüsselwörter

Gastritis - infektiöse Kolitis - Maldigestion - eosinophile Gastroenteritis - Aszites - Pathologie - Glukokortikoide
 

  • References

  • 1 Baig MA, Qadir A, Rasheed J. A review of eosinophilic gastroenteritis. J Natl Med Assoc 2006; 98: 1616-1619
    PubMedGoogle Scholar
  • 2 Klein NC, Hargrove RL, Sleisenger MH et al. Eosinophilic gastroenteritis. Medicine (Baltimore) 1970; 49: 299-319
    CrossrefPubMedGoogle Scholar
  • 3 Zhou HB, Chen JM, Du Q. Eosinophilic gastroenteritis with ascites and hepatic dysfunction. World J Gastroenterol 2007; 13: 1303-1305
    PubMedGoogle Scholar
  • 4 Fenoglio LM, Benedetti V, Rossi C et al. Eosinophilic gastroenteritis with ascites: a case report and review of the literature. Dig Dis Sci 2003; 48: 1013-1020
    CrossrefPubMedGoogle Scholar
  • 5 Harmon WA, Helman CA. Eosinophilic gastroenteritis and ascites. J Clin Gastroenterol 1981; 3: 371-373
    CrossrefPubMedGoogle Scholar
  • 6 Talley NJ, Shorter RG, Phillips SF et al. Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. Gut 1990; 31: 54-58
    Google Scholar
  • 7 Oyaizu N, Uemura Y, Izumi H et al. Eosinophilic gastroenteritis. Immunohistochemical evidence for IgE mast cell-mediated allergy. Acta Pathol Jpn 1985; 35: 759-766
    PubMedGoogle Scholar
  • 8 Von Wattenwyl F, Zimmermann A, Netzer P. Synchronous first manifestation of an idiopathic eosinophilic gastroenteritis and bronchial asthma. Eur J Gastroenterol Hepatol 2001; 13: 721-725
    CrossrefPubMedGoogle Scholar
  • 9 Freeman HJ. Longstanding eosinophilic gastroenteritis of more than 20 years. Can J Gastroenterol 2009; 23: 632-634
    PubMedGoogle Scholar
  • 10 Kalantar SJ, Marks R, Lambert JR et al. Dyspepsia due to eosinophilic gastroenteritis. Dig Dis Sci 1997; 42: 2327-2332
    CrossrefPubMedGoogle Scholar
  • 11 Lee J, Dierkhising R, Wu TT et al. Eosinophilic gastrointestinal disorders (EGID) with peripheral eosinophilia: a retrospective review at Mayo Clinic. Dig Dis Sci 2011; 56: 3254-3261
    CrossrefPubMedGoogle Scholar
  • 12 Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol 2004; 113: 11-28
    CrossrefPubMedGoogle Scholar
  • 13 Yan BM, Shaffer EA. Primary eosinophilic disorders of the gastrointestinal tract. Gut 2009; 58: 721-732
    CrossrefPubMedGoogle Scholar
  • 14 Deslandres C, Russo P, Gould P et al. Perforated duodenal ulcer in a pediatric patient with eosinophilic gastroenteritis. Can J Gastroenterol 1997; 11: 208-212
    PubMedGoogle Scholar
  • 15 Katz AJ, Goldman H, Grand RJ. Gastric mucosal biopsy in eosinophilic (allergic) gastroenteritis. Gastroenterology 1977; 73: 705-709
    PubMedGoogle Scholar
  • 16 Tien FM, Wu JF, Jeng YM et al. Clinical features and treatment responses of children with eosinophilic gastroenteritis. Pediatr Neonatol 2011; 52: 272-278
    CrossrefPubMedGoogle Scholar
  • 17 Murata A, Akahoshi K, Kouzaki S et al. Eosinophilic gastroenteritis observed by double balloon enteroscopy and endoscopic ultrasonography in the whole gastrointestinal tract. Acta Gastroenterol Belg 2008; 71: 418-422
    PubMedGoogle Scholar
  • 18 Alnaser S, Aljebreen AM. Endoscopic ultrasound and hisopathologic correlates in eosinophilic gastroenteritis. Saudi J Gastroenterol 2007; 13: 91-94
    CrossrefPubMedGoogle Scholar
  • 19 Horton KM, Corl FM, Fishman EK. CT of nonneoplastic diseases of the small bowel: spectrum of disease. J Comput Assist Tomogr 1999; 23: 417-428
    CrossrefPubMedGoogle Scholar
  • 20 Savino A, Salvatore R, Cafarotti A et al. Role of ultrasonography in the diagnosis and follow-up of pediatric eosinophilic gastroenteritis: a case report and review of the literature. Ultraschall Med 2011; 32: 57-62
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 21 Zhang L, Duan L, Ding S et al. Eosinophilic gastroenteritis: clinical manifestations and morphological characteristics, a retrospective study of 42 patients. Scand J Gastroenterol 2011; 46: 1074-1080
    Google Scholar
  • 22 Kelly HW, Van Natta ML, Covar RA et al. Effect of long-term corticosteroid use on bone mineral density in children: a prospective longitudinal assessment in the childhood Asthma Management Program (CAMP) study. Pediatrics 2008; 122: 53-61
    CrossrefPubMedGoogle Scholar
  • 23 Pérez-Millán A, Martín-Lorente JL, López-Morante A et al. Subserosal eosinophilic gastroenteritis treated efficaciously with sodium cromoglycate. Dig Dis Sci 1997; 42: 342-344
    CrossrefPubMedGoogle Scholar
  • 24 Urek MC, Kujundzić M, Banić M et al. Leukotriene receptor antagonists as potential steroid sparing agents in a patient with serosal eosinophilic gastroenteritis. Gut 2006; 55: 1363-1364
    CrossrefPubMedGoogle Scholar
  • 25 De Maeyer N, Kochuyt AM, Van Moerkercke W et al. Montelukast as a treatment modality for eosinophilic gastroenteritis. Acta Gastroenterol Belg 2011; 74: 570-575
    PubMedGoogle Scholar