説明のつかない慢性の腹痛として提示する好酸球性胃腸炎

Eosinophilic Gastroenteritis Presenting As Unexplained Chronic Abdominal Pain.

• Salem Gaballa
• Kyaw M Hlaing
• Nathan Mahler
• Richard Hargrove
• Marigny Roberts

抄録

27歳の白人女性が，吐き気と下痢を伴う再発性の間欠性腹痛で4か月間に3回入院した．消化管（GI）出血の徴候や症状は認められなかった．便潜血検査および便性腸内病原体検査は陰性であった。上部内視鏡検査では食道粘膜と十二指腸粘膜は正常であったが，胃粘膜生検では好酸球浸潤が20個以上/HPF（High Power Field）であった．これらの所見に基づいて、彼女は好酸球性胃腸炎（EGE）と診断されました。EGEの確定診断は、消化管粘膜生検の分析と末梢血好酸球数の上昇の両方で確認されるべきである。具体的には、粘膜組織の組織学的評価で好酸球浸潤率が20個/HPFを示さなければならない。

A 27-year-old Caucasian female was hospitalized three times over a four-month period for recurrent, intermittent abdominal pain associated with nausea and diarrhea. No signs or symptoms of gastrointestinal (GI) bleeding were present. A stool occult blood test and stool enteric pathogen tests were negative. A complete blood count (CBC) revealed a peripheral blood eosinophil count of 1080 cells /µL without any inflammatory reaction. An upper endoscopy showed grossly normal-appearing esophageal and duodenal mucosa; however, a gastric mucosal biopsy showed an eosinophil infiltration of ≥20 eosinophils/high power field (HPF). Based on these findings, she was diagnosed with eosinophilic gastroenteritis (EGE). A definitive diagnosis of EGE should be confirmed with both an analysis of gastrointestinal mucosal biopsy and an elevated peripheral blood eosinophil count. Specifically, histological evaluation of the mucosal tissue must show an eosinophilic infiltration rate of 20 eosinophils/HPF. The diagnosis should be followed by an extensive review of the patient's allergic disease history.

Copyright © 2020, Gaballa et al.