Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2017; 23(19): 3556-3564
Published online May 21, 2017. doi: 10.3748/wjg.v23.i19.3556
Diagnosis of eosinophilic gastroenteritis is easily missed
Kodjo-Kunale Abassa, Xian-Yi Lin, Jie-Ying Xuan, Hao-Xiong Zhou, Yun-Wei Guo
Kodjo-Kunale Abassa, Xian-Yi Lin, Jie-Ying Xuan, Hao-Xiong Zhou, Yun-Wei Guo, Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Author contributions: Abassa KK and Lin XY contributed equally to this work; Guo YW designed the study; Abassa KK, Lin XY, Xuan JY, Zhou HX and Guo YW performed the research; Abassa KK and Lin XY analyzed the data; Abassa KK and Guo YW wrote the paper.
Supported by Guangdong Science and Technology Program, No. 2016A020216012.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Third Affiliated Hospital of Sun Yat-Sen University.
Clinical trial registration statement: This study is registered at Chinese Clinical Trial Registry (ChiCTR). The registration identification numbers are ChiCTR-ORD-16009004 for the retrospective study and ChiCTR-DOD-16009003 for the prospective study.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yun-Wei Guo, MD, PhD, Associate Professor, Department of Gastroenterology, the Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong Province, China. guoyw1973@hotmail.com
Telephone: +86-20-85252156 Fax: +86-20-85253336
Received: January 22, 2017
Peer-review started: January 23, 2017
First decision: February 23, 2017
Revised: March 6, 2017
Accepted: April 12, 2017
Article in press: April 12, 2017
Published online: May 21, 2017
Processing time: 117 Days and 14.1 Hours
Abstract
AIM

To analyze the clinical characteristics of eosinophilic gastroenteritis (EGE) and to investigate the situations of missed diagnosis of EGE.

METHODS

First, the clinical characteristics of 20 EGE patients who were treated at our hospital were retrospectively summarized. Second, 159 patients who underwent gastroscopy and 211 patients who underwent colonoscopy were enrolled. The pathological diagnosis showed only chronic inflammation in their medical records. The biopsy slides of these patients were reevaluated to determine the number of infiltrating eosinophils in order to assess the probability of a missed diagnosis of EGE. Finally, 122 patients who experienced refractory upper gastrointestinal symptoms for at least one month were recruited. At least 6 biopsy specimens were obtained by gastroscopy, and the number of eosinophils that had infiltrated was evaluated. Those who met the pathological diagnostic criteria of EGE underwent further examination to confirm the diagnosis of EGE. The probability of a missed diagnosis of EGE was prospectively investigated.

RESULTS

Among the 20 patients with EGE, mucosal EGE was found in 15 patients, muscular EGE was found in 3 patients and serosal EGE was found in 2 patients. Abdominal pain was the most common symptom. The number of peripheral blood eosinophils was elevated in all 20 patients, all of whom were sensitive to corticosteroids. Second, among the 159 patients who underwent gastroscopy, 7 (4.40%) patients met the criteria for pathological EGE (eosinophil count ≥ 25/HPF). Among the 211 patients who underwent colonoscopy, 9 (4.27%) patients met the criteria for pathological EGE (eosinophil count ≥ 30/HPF). No patients with eosinophil infiltration were diagnosed with EGE in clinical practice before or after endoscopy. Although these patients did not undergo further examination to exclude other diseases that can also lead to gastrointestinal eosinophil infiltration, these might be the cases where the diagnosis of EGE was missed. Finally, among the 122 patients with refractory upper gastrointestinal symptoms, eosinophil infiltration was seen in 7 patients (5.74%). The diagnosis of EGE was confirmed in all 7 patients after the exclusion of other diseases that can also lead to gastrointestinal eosinophil infiltration. A positive correlation was observed between the duration of the symptoms and the risk of EGE (r = 0.18, P < 0.01). The patients whose symptoms persisted longer than 6 mo more readily developed EGE. None of the patients were considered to have EGE by their physicians before endoscopy.

CONCLUSION

Although EGE is a rare inflammatory disorder, it is easily misdiagnosed. When a long history of abdominal symptoms fails to improve after conventional therapy, EGE should be considered.

Keywords: Eosinophilic gastroenteritis; Missed diagnosis; Eosinophil; Gastroscopy; Colonoscopy

Core tip: Eosinophilic gastroenteritis (EGE) is a rare but easily missed disorder. In our study, the biopsy slides from the patients who underwent gastroscopy or colonoscopy were reevaluated. We found that a diagnosis of EGE might have been missed in 4.40% (7/159) patients who underwent gastroscopy and in 4.27% (9/211) who underwent colonoscopy. Finally, a prospective study was performed and showed that in patients with refractory upper gastrointestinal symptoms, 5.74% (7/122) of patients represent a missed diagnosis of EGE. Therefore, physicians should increase their alertness and improve communication with pathologist to reduce the rate of missed diagnosis of EGE.