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2017 ; 23
(19
): 3556-3564
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Diagnosis of eosinophilic gastroenteritis is easily missed
#MMPMID28596692
Abassa KK
; Lin XY
; Xuan JY
; Zhou HX
; Guo YW
World J Gastroenterol
2017[May]; 23
(19
): 3556-3564
PMID28596692
show ga
AIM: To analyze the clinical characteristics of eosinophilic gastroenteritis
(EGE) and to investigate the situations of missed diagnosis of EGE. METHODS:
First, the clinical characteristics of 20 EGE patients who were treated at our
hospital were retrospectively summarized. Second, 159 patients who underwent
gastroscopy and 211 patients who underwent colonoscopy were enrolled. The
pathological diagnosis showed only chronic inflammation in their medical records.
The biopsy slides of these patients were reevaluated to determine the number of
infiltrating eosinophils in order to assess the probability of a missed diagnosis
of EGE. Finally, 122 patients who experienced refractory upper gastrointestinal
symptoms for at least one month were recruited. At least 6 biopsy specimens were
obtained by gastroscopy, and the number of eosinophils that had infiltrated was
evaluated. Those who met the pathological diagnostic criteria of EGE underwent
further examination to confirm the diagnosis of EGE. The probability of a missed
diagnosis of EGE was prospectively investigated. RESULTS: Among the 20 patients
with EGE, mucosal EGE was found in 15 patients, muscular EGE was found in 3
patients and serosal EGE was found in 2 patients. Abdominal pain was the most
common symptom. The number of peripheral blood eosinophils was elevated in all 20
patients, all of whom were sensitive to corticosteroids. Second, among the 159
patients who underwent gastroscopy, 7 (4.40%) patients met the criteria for
pathological EGE (eosinophil count ? 25/HPF). Among the 211 patients who
underwent colonoscopy, 9 (4.27%) patients met the criteria for pathological EGE
(eosinophil count ? 30/HPF). No patients with eosinophil infiltration were
diagnosed with EGE in clinical practice before or after endoscopy. Although these
patients did not undergo further examination to exclude other diseases that can
also lead to gastrointestinal eosinophil infiltration, these might be the cases
where the diagnosis of EGE was missed. Finally, among the 122 patients with
refractory upper gastrointestinal symptoms, eosinophil infiltration was seen in 7
patients (5.74%). The diagnosis of EGE was confirmed in all 7 patients after the
exclusion of other diseases that can also lead to gastrointestinal eosinophil
infiltration. A positive correlation was observed between the duration of the
symptoms and the risk of EGE (r = 0.18, P < 0.01). The patients whose symptoms
persisted longer than 6 mo more readily developed EGE. None of the patients were
considered to have EGE by their physicians before endoscopy. CONCLUSION: Although
EGE is a rare inflammatory disorder, it is easily misdiagnosed. When a long
history of abdominal symptoms fails to improve after conventional therapy, EGE
should be considered.