To summarize the clinical characteristics, treatment strategies and prognosis of pediatric eosinophilic gastroenteritis (EGE) in children presenting with edema and hypoproteinemia as the main clinical manifestations.

A total of 8 children with EGE (labeled as child 1 to child 8) presenting with edema and hypoproteinemia as the main clinical manifestations, who were diagnosed and treated at the Capital Center for Children′s Health, Capital Medical University from January 2015 to December 2022, were selected as the research subjects. Clinical medical records and follow-up data of all patients were retrospectively analyzed to summarize the clinical characteristics of EGE. This study was approved by the Ethics Committee of the Capital Center for Children′s Health, Capital Medical University (Approval No. SHERLLM2024010).

The diagnosis, treatments, follow-up and prognosis of the 8 children with EGE in this study were as follows. ① Among 8 children with EGE, 4 cases were boys and 4 cases were girls, with an average age of 4 years and 7 months. ② Every child initially presented with edema as the primary symptom: 3 cases had isolated edema; 3 cases had edema with vomiting, abdominal pain, diarrhea and bloating; 1 case had edema with pale complexion; 1 case had edema with black stools. ③ Laboratory testing showed that all patients had reduced serum albumin (14.0-23.4 g/L) and serum globulin (9.1-14.5 g/L). We also found elevated peripheral blood eosinophil (EOS) counts in 7 children, elevated total serum immunoglobulin (Ig)E in 2 children, and low protein levels with anemia in 4 children. ④ Imaging and endoscopic workups revealed that 5 children had lesions in the stomach and duodenum, 1 child in the ileocecal area, and 2 children in the colon and rectum. Endoscopic results were non-specific across the cohort, with the most common findings being mucosal congestion, swelling, redness and erosions; 1 child had no remarkable findings on endoscopy. ⑤ Biopsies taken from multiple parts of the digestive tract demonstrated chronic inflammation of the mucosa in the stomach, duodenum, colon and rectum, with EOS infiltrating the lamina propria in all cases. ⑥ All 8 children required albumin infusions during their hospital stay. For first-line treatment, 7 children were managed with dietary therapy, including 5 children followed a targeted elimination diet based on allergy testing, 2 children avoided 6 common high-allergy foods including seafood, red meat, nuts, eggs and shellfish, and child 7 was given an amino acid-based formula due to his young age. Alongside first-line treatment, 7 children were also prescribed glucocorticoids once EGE was definitively diagnosed. ⑦ Within 1 to 4 weeks of starting these treatments regimen, all children had complete resolution of edema and other gut symptoms, and their peripheral blood EOS levels dropped back to normal.⑧ We followed the 8 children for 12 to 18 months, 7 children had sustained improvement in their clinical symptoms, while child 8 continued to have symptom flares after 15 months of follow-up.

For children with EGE presenting with edema and hypoproteinemia as the main clinical manifestations, no specific clinical symptoms or endoscopic signs can be observed. The diagnosis of this disease mainly relies on the histopathological examination of the gastrointestinal mucosa, for which multiple deep biopsies from different sites should be performed to avoid missed diagnosis. Patient with this disease have a favorable therapeutic response to dietary avoidance therapy and glucocorticoid therapy.