Eosinophilic Gastroenteritis with Unusual Presentation: Clinical Experience and Review of the Literature

嗜伊紅性胃腸炎是一少見而原因不明的疾病，十五年來本院共經驗9例嗜伊紅性胃腸炎病例，診斷標準為腸道黏膜病理組職切片有瀰漫性之嗜伊紅性白血球浸潤，且併有血液中嗜伊紅性白血球上升，並排除其他能導致嗜伊紅性白血球上升之疾病。嗜伊紅性胃腸炎之臨床表現變化多端，從機能性腸胃症候群、消化性潰瘍、腸胃道出血、幽門阻塞、十二指腸阻塞併急性胰臟炎、十二指腸炎，吸收不良症候群、急性腸胃炎併發燒、小腸阻塞併破裂、黃疸併肝腫大、腹水、淋巴腺腫大、大腸炎等之症狀及表現不一而足。病人年齡從17歲至80歲，平均49歲；男女比例為7比2；9例中3例有食物過敏、過敏性鼻炎或外因性氣管性氣喘，對副腎皮質素均有反應，但當副腎皮質素劑量減低或停藥時，症狀易在數月至數年間復發，9例中8例皆如此，只有1例無復發，反應良好；而有1例雖對副腎皮質素有部份反應，卻因發生敗血症而死亡。嗜伊紅性胃腸炎有組織學上的浸潤可能侵犯到黏膜層，肌肉層及漿膜層。本系例9例均有黏膜層之侵犯，而以胃炎表現者4例，消化性潰瘍1例，十二指腸炎4例，吸收不良症候群1例，大腸炎1例；有3例侵犯及肌肉層，以部份幽門阻塞表現者有例，小腸阻塞1例，十二指腸阻塞l例，侵犯及漿膜層者有3例，其中有2例併腹水，1例併小腸破裂。臨床上從症狀出現到確定診斷之時間平均為2.4年，因此臨床上須有高度認知及警覺性，才能早期診斷及治療，避免延誤病情或不必要之手術。

關鍵字

嗜伊紅性胃腸炎

並列摘要

Eosinophilic gastroenteritis is a rare disease of unknown etiology. We reviewed 9 cases with unusual clinical presentations. The variety of gastrointestinal manifestations included functional bowel disease, gastritis, multiple peptic ulcers, upper gastrointestinal bleeding, pyloric obstruction, duodenal obstruction with acute pancreatitis, small intestinal obstruction with perforation, malabsorption, colitis with lower gastrointestinal bleeding, ascites, hepatomegaly, lymphadenopathy, and transient obstructive jaundice. Due to the patchy distribution of the disease, the initial endoscopic biopsies were negative in 3 of the cases and needed to be repeated with multiple biopsies before confirming the diagnosis. In 1 case a laparoscopic biopsy precluded the need to perform a laparotomy. Most patients experienced symptomatic relief after prednisolone treatment, but recurrences were common. Despite steroid treatment, 2 patients required segmental intestinal resections for small intestinal obstruction, and another patient died of sepsis while taking steroids.

並列關鍵字

Eosinophilic gastroenteritis

國際替代計量

Eosinophilic Gastroenteritis with Unusual Presentation: Clinical Experience and Review of the Literature

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