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目的探讨误诊为黏膜下肿瘤的嗜酸性粒细胞性胃炎(EG)患者的临床特征及内镜下表现,以有助于此类患者的诊断。方法对16例误诊为黏膜下肿瘤并行黏膜下剥离术(ESD)后病理诊断为嗜酸性粒细胞性胃炎患者的临床表现、实验室结果和内镜特点进行分析。结果 16例患者平均年龄为(51.56±11.48)岁,男女比例为4∶12,7例有药物过敏史,无明显食物过敏史。临床表现以腹痛、腹胀、恶心、呕吐、反酸、嗳气等消化不良症状为主,多数患者病程超过1年,且反复发作。周围血嗜酸细胞升高者仅2例,占12.5%。16例病例内镜下均表现为胃窦部黏膜隆起,表面光滑或者有轻度糜烂。超声胃镜下有14例表现为黏膜层、黏膜肌层或黏膜下层的低回声病变,2例黏膜下层混合回声病变,所有病例行ESD术后病理结果均提示胃窦黏膜嗜酸性粒细胞浸润(>15~20/Hp)。结论胃镜下表现为黏膜隆起的嗜酸性粒细胞性胃炎症状无特异性,外周血嗜酸性粒细胞数目大多无升高,诊断仅能依靠病理结合临床症状。若此类患者能在超声胃镜下取足够深度的黏膜活检或许能避免行ESD术。
Objective To investigate the clinical features and endoscopic findings of patients with eosinophilic gastritis (EG) who have been misdiagnosed as submucosal tumors in order to facilitate the diagnosis of these patients. Methods The clinical manifestations, laboratory findings and endoscopic features of 16 patients with misdiagnosed as submucosal tumors undergoing submucosal dissection (ESD) and pathologically diagnosed as eosinophilic gastritis were analyzed. Results The average age of 16 patients was (51.56 ± 11.48) years old, the ratio of male to female was 4: 12, 7 patients had history of drug allergy without obvious history of food allergy. Clinical manifestations of abdominal pain, abdominal distension, nausea, vomiting, acid reflux, belching and other symptoms of indigestion, most patients over one year duration, and recurrent. Only 2 cases of peripheral blood eosinophilia, accounting for 12.5%. 16 cases of endoscopic showed gastric mucosal uplift, smooth surface or mild erosion. There were 14 cases of hypoechoic lesion in the mucosa, muscularis mucosa or submucosa under ultrasound gastroscopy, 2 cases of mixed hypoechoic lesions in the submucosa, pathological results of ESD in all cases showed eosinophilic infiltration of antral mucosa (> 15 ~ 20 / Hp). Conclusion Gastroscopy showed mucosal swelling eosinophilic gastritis nonspecific symptoms, the majority of peripheral blood eosinophils did not increase, the diagnosis can only rely on the pathology combined with clinical symptoms. If such patients can take adequate depth mucosal biopsy under ultrasound endoscopy may be able to avoid ESD surgery.