Eosinophilic gastroenteritis

　　The etiology of eosinophilic gastritis is not very clear. It is generally believed to be caused by an allergic reaction to exogenous or endogenous allergens. Nearly half of the patients have a personal or family history of asthma, allergic rhinitis, eczema, or urticaria; the symptoms of some patients can be induced by certain foods such as milk, eggs, lamb, shrimp, or certain drugs such as sulfonamides, metronidazole, and indomethacin; some patients have an increase in blood IgE levels and corresponding symptoms after consuming certain specific foods, thus it is believed that the disease is related to special food allergies.

　　Eosinophilic gastroenteritis is characterized by the infiltration of eosinophils in the tissue, and it is believed that the disease is caused by an allergic reaction induced by certain substances. It is considered a syndrome secondary to an unknown antigen and allergic reaction. It is generally believed that the disease is caused by the degranulation of eosinophils, the release of various enzymes, leading to tissue damage. The released eosinophil peroxidase further stimulates the release of histamine by mast cells, forming a vicious cycle. In addition to Type I allergy, immune dysfunction plays an important role in the pathogenesis of eosinophilic gastroenteritis, but no consistent immune dysfunction has been found. Some propose that eosinophilic gastroenteritis is a specific inflammatory disease of the digestive tract, and this eosinophilic inflammation is an allergic reaction caused by certain unknown antigens and can be part of the reaction to Crohn's disease, ulcerative colitis, amebic dysentery, and milk protein colitis.

　　Eosinophilic gastroenteritis in adolescence can lead to delayed growth and development, and amenorrhea may occur. Intestinal obstruction or pyloric stenosis may be seen when the muscular layer is primarily involved. Occasionally, eosinophilic infiltration of the esophageal muscular layer can cause achalasia.

　　Eosinophilic gastroenteritis can occur at any age, with the highest incidence between 20 to 50 years old, showing no gender difference. The lesions can invade the mucosa of the entire gastrointestinal tract from the esophagus to the colon. The clinical symptoms and signs of eosinophilic gastroenteritis depend on the depth of mucosal infiltration and the presence or absence of esophageal, gastric, duodenal, and colonic lesions. Clinically, it can be divided into 3 types.

　　1. Mucosal type (Type I) The disease mainly invades the mucosal tissue of the gastrointestinal tract, common symptoms include nausea, vomiting, abdominal pain, diarrhea, weight loss, and lumbar pain. The intake of special allergenic foods can worsen the symptoms. Physical examination may reveal skin eczema, urticaria, edema of the ankles and feet, and some patients may present with anemia due to gastrointestinal bleeding. Widespread lesions may cause malabsorption of the small intestine, protein-losing enteropathy, anemia, and other systemic manifestations. Adolescents may experience growth retardation, and women may have secondary amenorrhea.

　　2. Muscularis Type (Type II) Predominantly muscularis lesions, due to the thickening and stiffness of the gastric and small intestinal walls in this type, the clinical manifestations are mainly complete or incomplete pyloric and small intestinal obstruction, nausea and vomiting, abdominal pain, and antacid or anticholinergic drugs are difficult to alleviate.

　　3. Serosal Type (Type III) Subserosal lesions are relatively rare, accounting for about 10% of all eosinophilic gastroenteritis. Ascites may occur, containing a large number of eosinophils. This type can exist alone or coexist with other two types.

　　Eosinophilic gastroenteritis is a self-limiting变态反应性疾病 without effective preventive measures. Early detection and early treatment are the key to the prevention and treatment of the disease. Although it can recur, there is no evidence of malignant transformation in long-term follow-up, and the prognosis is generally good.

　　Eosinophilic gastroenteritis can be diagnosed by laboratory and imaging examinations, as follows:

　　Firstly, Laboratory Examinations

　　1. Blood Examination: 80% of patients have an increase in peripheral blood eosinophils, and patients with mucosal and submucosal lesions and muscularis lesions (1-2)×10⁹/L, and can reach 8×10 when the plasma cell lesion is predominant.⁹/L, and may also have iron deficiency anemia, decreased serum albumin, increased blood IgE, and rapid blood sedimentation rate.

　　2. Stool Examination: The significance of stool examination in eosinophilic gastroenteritis is to exclude extraintestinal parasitic infection. Some cases may show Charcot-Leyden crystals, and routine stool examination may show positive occult blood. Some patients may have mild to moderate steatorrhea, increased Cr-tagged albumin, increased alpha-antitrypsin clearance, and abnormal D-xylose absorption test.

　　Secondly, Imaging Examinations

　　1. X-ray Examination: Eosinophilic gastroenteritis lacks specificity, and X-ray barium meal may show mucosal edema, widened folds, nodular filling defects, thickening of the gastrointestinal wall, narrowing of the lumen, and obstruction.

　　2. CT Examination: CT examination can detect thickening of the gastrointestinal wall, enlargement of mesenteric lymph nodes, or ascites.

　　3. Endoscopy and Biopsy: Endoscopy and biopsy are suitable for eosinophilic gastroenteritis with lesions mainly in the mucosa and submucosa. Under the microscope, the mucosal folds may appear large, congested, edematous, ulcerated, or nodular. Biopsy can confirm the presence of a large number of eosinophils pathologically, which is valuable for diagnosis, but the biopsy tissue is not very valuable for patients with involvement mainly in the muscularis and serosa, and sometimes surgical pathological confirmation is required.

　　4. Peritoneal Puncture: Patients with ascites must undergo diagnostic peritoneal puncture. Ascites is exudative, containing a large number of eosinophils, and it is necessary to perform a peritoneal fluid smear staining to differentiate eosinophils from neutrophils.

　　5. Laparoscopic Examination: Laparoscopic examination lacks specific manifestations, with mild cases showing peritoneal congestion, and severe cases may resemble peritoneal metastatic cancer. The significance of laparoscopic examination lies in the biopsy of peritoneal mucosal tissue to obtain a pathological diagnosis.

　　6. Surgical Exploration: For suspected eosinophilic gastroenteritis, laparotomy is generally not performed to confirm the diagnosis, but surgery is carried out when there is intestinal obstruction, pyloric obstruction, or suspected tumor.

　　Eosinophilic gastroenteritis can be treated with the following dietary recipes: cut 30 grams of hawthorn into slices, dry-fry them, and then decoct them with 3 slices of ginger and 15 grams of brown sugar in water. Then take the juice. Take this juice twice a day, which can achieve the effects of astringent diarrhea, harmonizing the spleen and stomach, dispelling cold and stopping vomiting..

　　The traditional Chinese medicine treatment for eosinophilic gastroenteritis mainly focuses on dialectical treatment:
　　1. Spleen and stomach weakness: Deficiency in endowment, inherent spleen deficiency, vomiting and diarrhea occur after slight carelessness in diet, loose stools, vomiting clear water, intermittent, pale complexion, fatigue and drowsiness, pale tongue, weak pulse.
　　Treatment method: Strengthen the spleen and regulate qi, harmonize the stomach and stop diarrhea.
　　Herbal medicine: 3 grams of Ginseng, 12 grams of Atractylodes macrocephala, 10 grams of Dioscorea opposita, 12 grams of Poria, 12 grams of Dolichos lablab, 10 grams of Citrus reticulata, 3 grams of Amomum villosum, 12 grams of Coix seed, 6 grams of Licorice.
　　2. Food retention in the gastrointestinal tract: Nausea and aversion to food, worse after eating, vomiting feels better after vomiting; abdominal pain, foul-smelling diarrhea, uncomfortable gas, pain decreases after defecation, thick greasy tongue coating, slippery and solid pulse.
　　Treatment method: Digest food and relieve stagnation, harmonize the stomach and relieve vomiting.
　　Herbal medicine: 10 grams of Dried hawthorn, 10 grams of Shengjie Mi, 10 grams of Pinellia ternata, 12 grams of Poria, 10 grams of Citrus reticulata, 10 grams of Daifu Pi.
　　3. Cold and damp obstruction: Vomiting clear water, nausea, watery diarrhea, abdominal pain and intestinal rumbling with aversion to cold and fever, neck or whole body joint pain, thin white or white greasy tongue coating, slippery pulse.
　　Treatment method: Disperse cold and eliminate dampness, harmonize the middle and stop diarrhea.
　　Herbal medicine: 10 grams of Hoelen, 10 grams of Dahuopí, 10 grams of芷, 10 grams of Perilla frutescens, 12 grams of Poria, 10 grams of Pinellia ternata, 10 grams of Atractylodes macrocephala, 10 grams of Citrus reticulata, 10 grams of Magnolia officinalis, 5 grams of ginger, 6 grams of Licorice.
　　4. Gastrointestinal damp-heat: The disease starts suddenly, with frequent nausea, vomiting acid, abdominal pain in attacks, urgent defecation, uncomfortable defecation, yellow-brown stool with odor, thirst for drinking, irritability, short and red urine, yellow greasy tongue coating, slippery and rapid pulse or slippery and rapid pulse.
　　Treatment method: Clear heat and eliminate dampness, regulate qi and stop diarrhea.
　　Herbal medicine: 10 grams of Pueraria, 10 grams of Scutellaria baicalensis, 6 grams of Coptis, 10 grams of Moschus moschatus, 12 grams of Poria, 10 grams of Plantago asiatica, 10 grams of Dolichos lablab, 15 grams of Nelumbo nucifera leaves, 6 grams of Liquorice.