The oncologist · 2025
Rare occurrence of immunotherapy-related gastritis and duodenitis in a single tertiary medical center: a diagnostic challenge.
СтатьяНазвание и аннотация: Перевод в очереди
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Etan Tal, Bar-Yishay Iddo, Greenberg Ariel, Brazowsky Eli, Brezis Miriam R, Shachar Shlomit Strulov, Miodovnik Mor, Wolf Ido, Leshem Yasmin
Аннотация
INTRODUCTION: Immune checkpoint inhibitors (ICI) have revolutionized cancer treatment. While generally well-tolerated, some immune-related adverse events (ir-AEs) can impact patient care, highlighting the need for accurate diagnosis. Immunotherapy-related gastritis and duodenitis (ir-GD) is a rare ir-AE. Due to its low incidence and nonspecific symptoms, standardized diagnostic criteria and evidence-based treatment guidelines are lacking.
METHODS: We conducted a retrospective analysis of patients undergoing esophagogastroduodenoscopy (EGD) while receiving ICI. Our diagnostic criteria for ir-GD required at least two of three gastritis or duodenitis (GD) criteria (symptoms, EGD findings, or microscopic findings) along with at least one ICI-related criterion. Patients with ir-GD were compared to those without ir-GD.
RESULTS: Of 2553 patients treated with ICI between 2017 and 2023, 62 (2.4%) underwent EGD, of whom nine (0.4%) met the ir-GD diagnostic criteria. Nine other patients (0.4%) had GD unrelated to ICI. Notably, three of the nine patients (33%) with ir-GD had preexisting inflammatory gastrointestinal conditions, compared to two of 53 patients (4%) in the non-ir-GD cohort (P = .019). Patients with ir-GD were significantly more symptomatic (100% vs 58%, P = .009). However, no single symptom was specific to ir-GD. While eight of nine (89%) patients with ir-GD were treated with proton pump inhibitors, only three (33%) required corticosteroids. Symptom resolution occurred in all patients, and three patients successfully underwent rechallenge.
CONCLUSION: ir-GD is a rare ir-AE that can be challenging to distinguish from GD caused by other etiologies. Once diagnosed, clinicians may consider nonsteroidal treatment approaches in mild cases and, in selected cases, even ICI rechallenge.
METHODS: We conducted a retrospective analysis of patients undergoing esophagogastroduodenoscopy (EGD) while receiving ICI. Our diagnostic criteria for ir-GD required at least two of three gastritis or duodenitis (GD) criteria (symptoms, EGD findings, or microscopic findings) along with at least one ICI-related criterion. Patients with ir-GD were compared to those without ir-GD.
RESULTS: Of 2553 patients treated with ICI between 2017 and 2023, 62 (2.4%) underwent EGD, of whom nine (0.4%) met the ir-GD diagnostic criteria. Nine other patients (0.4%) had GD unrelated to ICI. Notably, three of the nine patients (33%) with ir-GD had preexisting inflammatory gastrointestinal conditions, compared to two of 53 patients (4%) in the non-ir-GD cohort (P = .019). Patients with ir-GD were significantly more symptomatic (100% vs 58%, P = .009). However, no single symptom was specific to ir-GD. While eight of nine (89%) patients with ir-GD were treated with proton pump inhibitors, only three (33%) required corticosteroids. Symptom resolution occurred in all patients, and three patients successfully underwent rechallenge.
CONCLUSION: ir-GD is a rare ir-AE that can be challenging to distinguish from GD caused by other etiologies. Once diagnosed, clinicians may consider nonsteroidal treatment approaches in mild cases and, in selected cases, even ICI rechallenge.