Abdominal ascites in children as the presentation of eosinophilic gastroenteritis: A surgeon's perspective.

BACKGROUND: Abdominal ascites is a common problem in general surgery. The causes include parasitic diseases, tuberculosis, malignancies, hypoalbuminemia, abdominal inflammatory diseases, and peritonitis. Eosinophilic gastroenteritis (EG) has also been reported to be an infrequent cause. To our knowledge, most instances of abdominal ascites from EG have occurred in adults and been reported by physicians or gastroenterologists. Herein, we report a small series of children who presented with eosinophilic ascites from a surgeon's perspective. METHODS: Five children with EG (male: 3; female: 2) were selected for review of medical data and diagnostic reports. RESULTS: The patients typically presented with intermittent abdominal pain (n = 5), diarrhea and nausea (n = 2), abdominal distension (n = 2), fever (n = 2), and histories of allergic disease (n = 3). Peripheral eosinophilia was regularly noted, three children showing elevated IgE levels. Abdominal ultrasound and CT performed in each instance demonstrated abdominal ascites. Surgical intervention was elected in two patients. Dietary control and a methylprednisolone regimen were then instituted in all children, followed by full clinical remissions. After a regular follow-up, all patients are doing well. CONCLUSIONS: Surgeons should be aware of EG as a rare cause of ascites, even in a pediatric population and especially in children with strong histories of allergic diseases, peripheral blood eosinophilia, and/or family histories of EG. It is important to avoid unnecessary surgical intervention, because dietary control and methylprednisolone treatment are effective remedies.

Efficacy of Sox10 Promoter Methylation in the Diagnosis of Intestinal Neuronal Dysplasia From the Peripheral Blood.

OBJECTIVES: Intestinal neuronal dysplasia (IND) is a common malformation of the enteric nervous system. Diagnosis requires a full-thickness colonic specimen and an experienced pathologist, emphasizing the need for noninvasive analytical methods. Recently, the methylation level of the Sox10 promoter has been found to be critical for enteric nervous system development. However, whether it can be used for diagnostic purposes in IND is unclear. METHODS: Blood and colon specimens were collected from 32 patients with IND, 60 patients with Hirschsprung disease (HD), and 60 controls. Sox10 promoter methylation in the blood and the Sox10 expression level in the colon were determined, and their correlation was analyzed. The diagnostic efficacy of blood Sox10 promoter methylation was analyzed by receiver operating characteristic curve. RESULTS: The blood level of Sox10 promoter methylation at the 32nd locus was 100% (90%-100%; 95% confidence interval [CI], 92.29%-96.37%) in control, 90% (80%-90%; 95% CI, 82.84%-87.83%) in HD, and 60% (50%-80%; 95% CI, 57.12%-69.76%) in IND specimens. Sox10 promoter methylation in the peripheral blood was negatively correlated with Sox10 expression in the colon, which was low in control, moderate in HD, and high in IND specimens (r = -0.89). The area under the curve of Sox10 promoter methylation in the diagnosis of IND was 0.94 (95% CI, 0.874-1.000, P = 0.000), with a cutoff value of 85% (sensitivity, 90.6%; specificity, 95.0%). By applying a cutoff value of 65%, promoter methylation was more indicative of IND than HD. DISCUSSION: The analysis of Sox10 promoter methylation in the peripheral blood can be used as a noninvasive method for IND diagnosis.