Abstract: Abstract Objective: To investigate the clinical features of eosinophilic gastroenteritis（EGE）in children with moderate or severe anemia as initial presentation. Methods: Medical records of EGE patients with moderate and severe anemia as initial presentation admitted to Affiliated Children's Hospital of Capital Institute of Pediatrics from January 2015 to December 2019 were retrospectively analyzed. The diagnosis and classification of EGE were performed according to Talley's and Klein's criteria. Results: A total of 6 children were included with two females and four males. The age of onset was from 1 year and 3 months old to 11 years old. All of 6 cases had symptoms of anemia as initial presentation including pale face, poor spirit and fatigue. There were 3 cases of black stool, 3 cases of abdominal pain, 1 case of vomiting, and 1 case of edema and hypoproteinemia. Blood smear showed hemoglobin 53 to 78 g·L-1 as microcytic hypochromic anemia. Blood eosinophils increased in 5 cases ［(0.75 to 4.20)×109·L-1］. The occult blood of stool was positive in 6 cases. Serum IgE increased in 5 cases. Imaging and endoscopic examination showed that 6 cases involved gastric and duodenal lesions, 3 cases involved terminal ileum lesions and 2 cases involved colon and rectum lesions. Endoscopy showed congestion, swelling, erythema, erosion and ulcers. The pathological manifestations were chronic inflammation of gastric, duodenal, colon and rectum mucosa and inherent layer of a large number of eosinophilic infiltration. Gastroscopy showed that the ulcer had not been healed in 3 cases after treatment with proton pump inhibitor. Six patients were all treated with glucocorticoid. The digestive tract symptoms disappeared within 1 week of treatment and the blood eosinophil count decreased to the normal level. Three cases with gastrointestinal ulcers required long-term maintenance of methylprednisolone. Conclusion: Children with symptoms of anemia as initial presentation should be considered not only blood system diseases, but also EGE of less obvious gastrointestinal symptoms complicated with chronic gastrointestinal bleeding. Differential diagnosis of refractory upper gastrointestinal ulcers should take EGE into consideration. Recurrence and glucocorticoid dependence are more common for children with gastric or duodenal ulcers.