Eosinophilic gastroenteritis: Pathogenesis, diagnosis, and treatment / 中华医学杂志(英文版)

Eosinophilic gastroenteritis (EGE) is a gastrointestinal disorder of unclear etiology that is characterized by eosinophilic infiltration of the stomach and small intestine, and consists of mucosal, muscular, and serosal subtypes. Eosinophilic infiltration of the gastrointestinal tract is a fundamental histopathological characteristic of EGE and is driven by several T-helper type 2 (Th2)-dependent cytokines and induced by food allergy. Due to the lack of a diagnostic gold standard, EGE has a high rate of delayed diagnosis or misdiagnosis. However, several new diagnostic strategies have been developed, such as novel genetic biomarkers and imaging tests. Although dietary therapy and corticosteroids remain the common choices for EGE treatment, recent decades have seen the emergence of novel treatment alternatives, such as biologics that target particular molecules involved in the pathogenic process. Preliminary investigations and clinical trials have demonstrated the efficacy of biologics and provided additional insights for the era of refractory or corticosteroid-dependent EGE biologics.

Network Meta-analysis of oral Chinese patent medicine in adjuvant treatment of rotavirus gastroenteritis in children / 中国中药杂志

This study aimed to evaluate the efficacy and safety of various oral Chinese patent medicines in the adjuvant treatment of rotavirus gastroenteritis(RVGE) in children based on network Meta-analysis. Randomized controlled trial(RCT) of oral Chinese patent medicine in the adjuvant treatment of RVGE in children was retrieved from the databases such as CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, EMbase, and Web of Science from database inception to October 22, 2022. The quality of the included RCT was evaluated according to the Cochrane risk-of-bias tool, and the data were analyzed by RevMan 5.4 and Stata 16 software. Sixty-three RCTs were included, with 11 oral Chinese patent medicines involved, including Xingpi Yanger Granules, Weichang'an Pills, Qiuxieling Mixture, Erxieting Granules, and Changyanning Granules/Syrup. The results of the network Meta-analysis showed that in terms of clinical total effective rate, the top 3 optimal interventions were Changyanning Granules/Syrup, Xiaoer Guangpo Zhixie Oral Liquid, and Xiaoer Shuangjie Zhixie Granules combined with conventional western medicine. In terms of the anti-diarrheal time, the top 3 optimal interventions were Shenling Baizhu Granules, Qiuxieling Mixture, and Shuangling Zhixie Oral Liquid combined with conventional western medicine. In terms of the antiemetic time, the top 3 optimal interventions were Changyanning Granules/Syrup, Xingpi Yanger Granules, and Xiaoer Shuangjie Zhixie Granules combined with conventional western medicine. In terms of the antipyretic time, the top 3 optimal interventions were Shenling Baizhu Granules, Xiaoer Shuangjie Zhixie Granules, and Qiuxieling Mixture combined with conventional western medicine. In terms of the negative conversion rate of rotavirus, the top 3 optimal interventions were Xingpi Yanger Granules, Erxieting Granules, and Cangling Zhixie Oral Liquid combined with conventional western medicine. In terms of reducing creatine kinase isoenzyme MB(CK-MB) level, the top 3 optimal interventions were Weichang'an Pills, Xingpi Yanger Granules, and Xiaoer Shuangjie Zhixie Granules combined with conventional western medicine. In terms of adverse reactions, no se-rious adverse reactions were reported in all studies. Oral Chinese patent medicines in the adjuvant treatment of children with RVGE have their own advantages, Specifically, Changyanning Granules/Syrup + conventional western medicine focuses on improving the clinical total effective rate and shortening the antiemetic time, Shenling Baizhu Granules + conventional western medicine on shortening the anti-diarrheal time and antipyretic time, Xingpi Yanger Granules + conventional western medicine on improving the negative conversion rate of rotavirus, and Weichang'an Pills + conventional western medicine on reducing the CK-MB level. Limited by the quantity and quality of literature included in this study, the results need to be verified by high-quality RCT with a larger sample size.

Enterite mesentérica como complicação rara do lúpus eritematoso sistêmico / Mesenteric enteritis as a rare complication of systemic lupus erythematosus

A dor abdominal no paciente com lúpus eritematoso sistêmico tem amplo espectro clínico, variando desde condições inespecí- ficas, como diarreia e vômitos, até eventos de importante morbi- mortalidade, como o abdome agudo inflamatório e/ou perfura- tivo. A seguir, descreve-se um caso de paciente do sexo feminino, de 23 anos, internada por dor abdominal associada a vômitos e à diarreia crônica e progressiva. Foi diagnosticada com lúpus eritematoso sistêmico há 2 anos. Durante a internação, evoluiu com quadro de abdome agudo, e foi realizada tomografia compu- tadorizada de abdome, revelando importante edema de parede intestinal difuso. Isso, somado a alterações clínico-laboratoriais, permitiu o diagnóstico de enterite lúpica. Foi realizado tratamen- to conservador, com corticoterapia e terapia de suporte com correção de distúrbios eletrolíticos severos, sendo iniciado ciclo- fosfamida, com resolução dos sintomas gastrintestinais.

Abdominal pain in patients with systemic lupus erythematosus has a broad clinical spectrum, ranging from nonspecific symp- toms, such as diarrhea and vomiting, to events of significant morbidity and mortality, such as acute inflammatory and/or per- forating abdomen. This article describes a case of a 23-year-old female patient hospitalized for abdominal pain, associated with vomiting and progressive chronic diarrhea. She was diagnosed with systemic lupus erythematosus 2 years ago. During hospita- lization, the patient progressed with acute abdomen, and an ab- dominal computed tomography scan was performed, revealing major diffuse intestinal wall edema. This, added to clinical and laboratories alterations, allowed the diagnosis of lupus enteritis. A conservative treatment with corticotherapy and supportive therapy with correction of severe electrolyte disturbances were initiated, as well as the prescription of cyclophosphamide, with resolution of gastrointestinal symptoms.

Predictive factors for glucocorticoid therapy in children with eosinophilic gastroenteritis / 中国当代儿科杂志

OBJECTIVES@#To study the predictive factors for glucocorticoid therapy by analyzing the association between the clinical features and treatment regimens in children with eosinophilic gastroenteritis.@*METHODS@#A retrospective analysis was performed on the medical data of 182 children with eosinophilic gastroenteritis who were admitted to Guangzhou Women and Children's Medical Center from January 2012 to December 2020. According to whether glucocorticoids were used, these children were divided into a glucocorticoid treatment group and a control group. The two groups were compared in terms of age, history of allergy, clinical symptoms, laboratory examination results, endoscopic findings, and pathological results of gastrointestinal mucosa. A multivariate logistic regression analysis was performed for the results with statistical significance.@*RESULTS@#Of the 182 children, 36 (19.8%) received glucocorticoid therapy. The rates of hematochezia, anemia, and mucosal ulceration/luminal stenosis under endoscopy and the mucosal eosinophil infiltration count were significantly higher in the glucocorticoid treatment group than those in the control group (@*CONCLUSIONS@#Mucosal ulceration/luminal stenosis under endoscopy or a significant increase in the mucosal eosinophil infiltration count based on pathology suggests that glucocorticoid therapy can be considered in children with eosinophil gastroenteritis.

Dificultades en el diagnóstico de enteritis lúpica: presentación de un caso / Lupus enteritis: report of one case

In lupus enteritis, circulating pathological immune complexes and thrombosis of intestinal vessels may occur, resulting in acute abdominal pain. We report a 24-year-old woman without a history of systemic lupus erythematosus (SLE), admitted for abdominal pain. An exploratory laparotomy found an appendicitis along with ascites. An appendectomy was performed, and the patient was discharged from the hospital two days later. Three days after discharge, the patient was admitted to another hospital due to the persistence of abdominal pain. An abdominal computed tomography scan showed diffuse mesenteric congestion, concentric bowel loops (double halo or target sign) and the presence of free fluid in the peritoneal cavity. Suspecting a rheumatic disorder, the diagnosis of SLE was confirmed by immunological studies. The patient was treated with pulses of methylprednisolone with good results.

Enteritis lúpica como manifestación inicial de lupus eritematoso sistémico: caso clínico / Lupus enteritis as initial manifestation of systemic lupus erythematosus: report of one case

Although gastrointestinal symptoms are not rare in Systemic lupus erythematosus, enteritis is an atypical manifestation of the disease. We report a 54 year-old woman who presented acute symptoms of diarrhea, fever and abdominal pain, receiving empiric antibiotic therapy for bacterial enteritis with no response. Computed tomography showed diffuse small intestine inflammation and serositis. Antinuclear antibodies, anti-Ro and anti-La were positive on blood tests. A lupic enteropathy was diagnosed and steroid treatment was initiated, with subsequent clinical improvement.

Eosinophilic Gastroenteritis Presenting as Small Bowel Obstruction.

Eosinophilic gastroenteritis is a rare disease of unknown etiology characterized by eosinophilic infiltration of bowel wall to a variable depth. A 38 year old female presented with loose stool and vomiting since 3 days. She gave history of pain abdomen and weight loss since six months. Barium study revealed ascending colon stricture just proximal to the hepatic flexure ? malignant. A colonic biopsy was done, which was reported as edematous colonic mucosa with mild increase in eosinophils. Intra-operatively, a dense long segment stricture was found in the ascending colon extending to the caecum which warranted a right hemicolectomy. Histopathology revealed dense infiltration of eosinophils in the entire thickness of ileal and caecal wall. The diagnosis of eosinophilic gastroenteritis was made. Patient responded well to steroids. The case is being reported to highlight its rarity due to caecal involvement, presentation as intestinal obstruction and missed diagnosis on endoscopic biopsy.

Successful Treatment of Eosinophilic Gastroenteritis with Clarithromycin

Eosinophilic gastroenteritis (EGE) is an uncommon disease characterized by eosinophilic infiltration of the gastrointestinal tract, which is usually associated with abdominal pain, diarrhea, ascites, and peripheral eosinophilia. Steroids remain the mainstay of treatment for EGE, but symptoms often recur when the dose is reduced. Macrolides have immunomodulatory effects as well as antibacterial effects. The immunomodulatory effect results in inhibition of T-lymphocyte proliferation and triggering of T-lymphocyte and eosinophil apoptosis. Macrolides also have a steroid-sparing effect through their influence on steroid metabolism. We report a rare case of EGE, which relapsed on steroid reduction but improved following clarithromycin treatment.

Avaliação de óleos essenciais de orégano e alecrim na prevenção da diarreia neonatal em leitões / Evaluation of oregano and rosemary essential oils for the prevention of neonatal diarrhea in piglets

Com objetivo de verificar o efeito preventivo da emulsão líquida de uma mescla de óleos essenciais de orégano (Origanum vulgare) e alecrim (Rosmarinus officinalis) no controle da diarreia neonatal em leitões lactantes foi realizado um experimento composto por dois tratamentos simples em um delineamento experimental inteiramente casualizado. Leitões de mesma leitegada, nascidos de fêmeas com ordens de partos variadas, foram divididos em 2 grupos de leitões sem manifestação clínica de diarreia neonatal. O primeiro grupo com 661 leitões recebeu o tratamento controle (1 mL kg-1 solução fisiológica) e o segundo grupo com 672 animais recebeu óleos essenciais de orégano (60% de carvacrol e 15% timol) e 2% de óleo essencial de alecrim, sob a forma de emulsão líquida a 5% na dose de 1 mL kg-1.. Todos os tratamentos foram administrados via oral no primeiro e terceiro dias de vida do suíno, sendo que, para o parâmetro índice de prevenção e causas de mortalidade dos leitões, cada animal representou uma repetição. Não houve diferença significativa entre os tratamentos quanto ao índice de prevenção da diarreia neonatal em leitões. Os resultados permitiram concluir que a mescla de óleos essenciais à base de orégano e alecrim não previne as diarreias neonatais dos leitões.

In order to verify the preventive effect of the liquid emulsion of a mix of essential oils of oregano (Origanum vulgare) and rosemary (Rosmarinus officinalis) in the control of neonatal diarrhea in nursing piglets, an experiment was conducted using a randomized experimental design composed by two simple treatments. Piglets from the same litter, born to females with different orders of births, were divided into two groups of piglets without clinical signs of neonatal diarrhea. The first group of 661 pigs received the control treatment (1 mL kg-1 saline) while the second group with 672 animals received essential oils of oregano (60% carvacrol and 15% thymol) and 2% essential oil of rosemary in the form of a 5% liquid emulsion at a dose of 1 mL kg-1. All the treatments were administered orally on the first and third day of the piglets' life, and in regard to the index parameter for the prevention and causes of mortality of piglets, each animal represented a repetition. There was no significant difference between the treatments related to the rate of prevention of neonatal diarrhea in piglets. The results showed that the mix of essential oils from oregano and rosemary do not prevent diarrhea in neonatal piglets.

Enteritis ulcerativa estenosante multifocal criptogénica (CMUSE) diagnosticada por enteroscopia doble balón: ¿una forma de vasculitis intestinal? / Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) diagnosed by double balloon enteroscopy: a type of intestinal vasculitis?

Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is a rare pathology with no more than 30 reported cases worldwide. The diagnosis requires a combination of clinical elements, imagenological and histological, and to rule out other pathologies. This is the case of a 36 year-old patient presenting anemia, abdominal pain and diarrhea related to immune manifestations with a CMUSE diagnosis. Double balloon enteroscopy was a critical tool for the diagnosis. The patient showed a good response to steroidal treatment with symptomatic remission.

La enteritis estenosante y ulcerativa multifocal idiopática (CMUSE) es una entidad poco frecuente con no más de 30 casos reportados a nivel mundial. El diagnóstico requiere una combinación de elementos clínicos, imagenológicos e histológicos, y descartar otras patologías. Presentamos el caso de una paciente de 36 años que se presenta con anemia, dolor abdominal y diarrea asociado a manifestaciones inmunológicas con diagnóstico de CMUSE. La enteroscopia Doble Balón fue una herramienta fundamental para el diagnóstico. Evolucionó con buena respuesta a tratamiento esteroidal con remisión sintomática mantenida.

Avances en el tratamiento farmacológico de las enfermedades inflamatorias del intestino delgado y del colon / Advances in pharmacological treatment of inflammatory diseases of small bowel and colon

Actualmente se dispone de fármacos de primera línea y de probada eficacia, como son los corticoesteroides, la sulfaslazina y el metronidazol; de 2a. línea como la azatioprina y la 6-mercaptopurina, cuya utilidad ya está demostrada y aún de 3a. línea que están comenzando a perfilarse, pero acerca de los cuales se requiere acumular mas experiencia. Es el caso del metotrexato y la ciclosporina. Estos recursos farmacológicos actualmente disponibles han modificado substancialmente la evolución, las complicaciones y el pronóstico de las enfermedades inflamatorias intestinales. En efecto, por una parte son capaces de inducir remisiones en un alto porcentaje de casos (probablemente mayor de 80 porciento) y lo que es tanto o más importante aún, mantener las remisiones obtenidas mediante tratamientos de largo plazo, con dosis reducidas, inductoras de bajos porcentajes de efectos adversos. Los resultados obtenidos con la sulfasalizina y especialmente con la azatioprina y la 6-mercaptopurina han sido particularmente satisfactorios en el tratamiento de la enfermedad de Crohn y muy especialmente en algunas de sus complicaciones, como las fístulas y las lesiones perianales que, hasta no hace mucho, constituían verdaderos desafíos médicos y quirúrgicos

Enteritis por Cryptosporidium en un paciente leucémico / Enteritis by Cryptosporidium in a leukemic patient

Se analiza el caso de un paciente de 2 años 7 meses con leucemia linfoblástica, que fue tratada con quimioterapia y radioterapia obteniéndose remisión de su enfermedad. Durante el sexto mes de tratamiento comenzó a sufrir diarrea con deposiciones profusas, 3 a 4 veces al día, y vómitos, sin fiebre: esta se prolongó durante 3 meses comprometiendo en forma importante el peso corporal y no respondió a tratamiento dietético ni a la administración de antimicrobíanos (Cotrimoxazol y Furazolidona). Se descartó el síndrome de malabsorción. Los exámenes de deposiciones fueron negativos para los enteroparásitos habituales (técnica de PAFS). Tampoco se recuperaron bacteria enteropatógenas (E. coli enteropatógenos serogrupos clásicos e invasores Shigella, Salmonella, Yersinia, Aeromonas y Campylobacter). Se comprobó infección por Cryptosporidium mediante tinción de Ziehl-Neelsen en frontis de 2 muestras de deposición. La paciente fue tratada con Eritromicina 50 mg x kg x día, durante 10 días, con excelente respuesta. Se analizan las técnicas de diagnóstico y posibilidades terapéuticas

La enteritis por campylobacter fetus / Enteritis by Campylobacter fetus

El Campylobacter jejuni ha sido reconocido recientemente como un patógeno importante en los humanos, y si se utilizan los medios de cultivo apropiados, probablemente se recobra de pacientes con diarreas agudas con la misma frecuencia que se recobran Salmonella o Shigella. Este organismo es responsable no sólo de cuadros de enteritis y diarreas agudas, sino que ha sido asociado a eritema nodoso, endocarditis, meningitis, abortos y proctitis entre otras enfermedades. Usualmente, el curso es autolimitado, recuperándose el paciente en menos de una semana. Sin embargo, en aquellos pacientes con diarreas prolongadas o cuadros de enteritis recurrentes, se recomienda tratamiento con eritromicina por vía oral. Los medios de cultivos simplificados y prácticos nos permiten hacer el diagnóstico de enteritis por campylobacter, por lo que debemos considerar este organismo y ordenarlo en las muestras de rutina en el paciente que se presenta con diarreas agudas

Infecciones entéricas por Campylobacter jejuni en Rosario / Enteric infections caused by Campylobacter jejuni in Rosario

Se aisló C. jejuni en 17 (6,14%) de 277 pacientes de distintos centros asistenciales de la ciudad de Rosario, Argentina, entre junio de 1982 y marzo de 1983 inclusive, y en ninguno de 45 testigos asintomáticos sin antecedentes diarreicos. Escherichia coli enteropatógeno (ECEP) se aisló en 21,8% y Shigella sp en 8,3% en los 277 enfermos. En un solo paciente se aisló ECEP más C. jejuni. No se aisló C. jejuni en niños menores de 1 mes ni en mayores de 18 meses. Las heces eran mucosas en 9 de 11 casos y sanguinolentas en 4 de 9 casos de campilobacteriosis. Dos pacientes presentaron nuevamente C. jejuni en sus heces 3 y 5 meses después del episodio de diarrea, respectivamente, uno de ellos sin haber recibido antibióticos. No se ha podido demostrar una diferencia significativa en el aislamiento en dos grupos de diferente nivel socio-económico