2017年 · 第37卷第06期

With the change of lifestyle, the improvement of living standard, and the progress of early examination and screening technology, the incidence and detection rate of intestinal diseases are increasing year by year in China, from colon polyps, colon adenoma to colon cancer, from IBD (UC, CD) to infectious enteritis, radiation enteritis, ischemic enteritis, antibiotic-related enteritis, NSAID-related enteritis, etc., from "diarrhea" (diarrhea) that ordinary people did not pay much attention to at first, to the improvement of people's living standard and health awareness, functional gastrointestinal diseases such as IBS have received attention, and intestinal diseases are getting more and more attention.

Gastroenterology Branch of Chinese Medical AssociationH.pyloriAnd the Peptic Ulcer Group "H.pyloriMaastricht-5 Consensus Workshop on Infection Management and 5th NationalH.pylori"Consensus Meeting on Infection Management" was held in Hangzhou, Zhejiang Province from December 15 to 16, 2016. China Gastroenterology andH.pyloriMore than 80 experts in the research field and members of the academic group attended the meeting.

eosinophilic gastroenteritis (EG) is a rare gastrointestinal inflammatory reaction disease characterized by eosinophil infiltration. Its specific etiology is unclear, and it may be related to endogenous or exogenous allergic reactions^[1]。 At present, it has been found that type Ⅰ allergy mediates the occurrence of EG, and with the participation of inflammatory response factors, it promotes the formation of gastrointestinal mucosal congestion, edema, erosion or ulcer^[2]。 EG is most likely to involve the stomach and small intestine, and is mainly characterized by elevated peripheral blood eosinophils and histological eosinophil infiltration. Its clinical manifestations lack specificity, and it is easy to miss and misdiagnose. The most effective treatment drug is glucocorticoid, but it is easy to relapse, and it is still effective to use glucocorticoid treatment again. The diagnosis and treatment of 2 patients with EG admitted to Chenggong Hospital affiliated to Xiamen University are reported as follows, and relevant domestic and foreign literatures are reviewed to improve the understanding of EG by domestic clinicians.

eosinophilic gastroenteritis (EG) is a rare disease characterized by diffuse or localized abnormal infiltration of eosinophils in the gastrointestinal tract. The clinical manifestations are diverse, including nausea, vomiting, abdominal pain, diarrhea, etc., often accompanied by elevated peripheral blood eosinophils. The medical records of a patient with EG admitted to the Department of Gastroenterology of Shanghai East China Hospital were retrospectively analyzed, and the diagnosis and treatment were discussed.

The patient, a 62-year-old male, experienced swallowing discomfort without obvious trigger for more than 3 months and went to the Department of Gastroenterology, West China Hospital, Sichuan University on March 22, 2016. In addition to swallowing discomfort, the patient had no swallowing obstruction, abdominal pain, melena, weight loss, etc. Past physical health, denying history of drinking alcohol and history of hepatitis. Physical examination at admission showed no abnormalities. There were no obvious abnormalities in blood routine, liver function, kidney function, blood glucose and blood lipid. Except for anti-HBs positive, all HBV markers were negative. Anti-HCV negative. Gastroscopy showed that a giant ulcer-type neoplasm could be seen 31~35 cm away from the incisors, involving 2/3 of the lumen, and was brittle. Under the light microscope, the tissue showed that the cancer cells were arranged in solid or glandular form, with obvious atypia, and no hepatocellular carcinoma (HCC) differentiation characteristics. Enhanced CT of the chest showed thickening of the lower thoracic and abdominal esophageal wall, uneven and narrow lumen, and no lymph node enlargement in the mediastinum. Serum AFP>1 210 μ g/L, CEA 22.65 μ g/L and CA19-9 11.7 kU/L. Enhanced CT examination of whole abdomen showed no signs of space occupation in liver, abdominal cavity and pelvic cavity. The immunohistochemical results of the tumor specimens showed strong positive AFP, and no HCC-like differentiation was observed, which confirmed the diagnosis of AFP-producing esophageal adenocarcinoma. SeeFigure 1。 Radical esophagectomy was recommended after surgical consultation, but the patient refused treatment for other reasons.

A 47-year-old male was admitted on August 5, 2016 due to epigastric pain for 2 d. The patient developed upper abdominal pain during driving 2 days ago, which was persistent, without fever, nausea, vomiting, diarrhea, hematemesis, melena and other discomfort. The patient had no history of long-term heavy drinking and history of hepatitis and tuberculosis.

A 35-year-old male was admitted to the hospital on 10 November 2015 due to hematochezia for 1 d. One day before admission, the patient developed melena with black blood clots and blood without obvious trigger, more than 20 times in total, with a total amount of about 2 500 mL, accompanied by palpitation, fatigue, upper abdominal pain, no damp and cold limbs, and no disturbance of consciousness. The patient had a history of hepatitis B for 10 years without antiviral therapy; He had a history of liver cirrhosis for 2 years and a history of alcohol consumption for more than 10 years, 150 g/d. Physical examination: body temperature 36.5 ℃, pulse 78 beats/min, breathing 18 beats/min, blood pressure 121/78 mmHg (1 mmHg =0.133 kPa), anemia, liver disease, mild yellowing of skin and sclera, scattered spider nevus on the chest, clear breathing sounds in both lungs, and no obvious dry and wet rales; The heart rate was 78 beats/min, the rhythm was uniform, and no additional heart sounds or murmurs were heard in the auscultation area of each valve; Soft abdomen, mild tenderness under the xiphoid process, no rebound pain and muscle tension, 2 cm under the spleen costs, positive mobile voicing; There was no edema in both lower limbs.

Clostridium difficile (Clostridium difficile) is an anaerobic Gram-positive toxin-producing bacterium, mainly spread through feces to mouth. It is the pathogen of pseudomembranous enteritis, which can infect the colon, causing diarrhea, fulminant enteritis and even death in patients. At present, there is still a lack of routine detection of Clostridium difficile infection in China, and large-scale epidemiological investigation is rare. The survey results of Huashan Hospital affiliated to Fudan University in Shanghai from 2007 to 2008 showed that the incidence rate of pseudomembranous enteritis was 13.04/10,000^[1]。 In 2010, the survey of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine found that the infection rate of Clostridium difficile after application of antibacterial drugs was 23.8%^[2]。

IBD is a chronic recurrent intestinal inflammatory reactive disease whose etiology and pathogenesis have not been fully elucidated. It mainly includes two clinical types: UC and CD. It has been reported in the literature that changes in intestinal flora, impaired intestinal mucosal barrier function, abnormal activation of immune response, genetic susceptibility and environmental factors are involved in the occurrence and development of IBD^[1]。 colitis-associated colorectal cancer (CAC) is one of the serious complications of IBD patients. The risk of developing colorectal cancer in IBD patients is significantly higher than that in healthy people. The probability of cancer in UC patients with a disease course of more than 30 years is as high as 18%, and the fatality rate of CAC is also significantly higher than that of sporadic colon cancer^[2]。

autoimmune hepatitis (AIH) is an inflammatory lesion of the liver parenchyma caused by autoimmune reaction against liver cells. It is characterized by positive serum autoantibodies, high immunoglobulin G (IgG) and/or gamma globulinemia, and interfacial inflammatory reaction in liver tissue. If not treated, it can often lead to liver cirrhosis and liver failure^[1,2]。 However, viral hepatitis, including hepatitis B and C, are often associated with autoimmune phenomena, which are difficult to distinguish from AIH^[3,4]。 The diagnostic criteria for AIH included viral hepatitis as a subtractive item, mainly excluding hepatitis B and hepatitis C. However, patients with AIH with viral hepatitis are not uncommon clinically^[3]。 It is reported in the literature that AIH patients with viral hepatitis are all patients with chronic viral hepatitis^[5,6,7]。 The progress in the diagnosis and treatment of AIH with chronic hepatitis B and/or chronic hepatitis C is summarized below.