Journal of gastroenterology · 2025
Clinical manifestations of immunoglobulin G4-related gastrointestinal disease: a nationwide multicenter retrospective study.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Masuda Atsuhiro, Notohara Kenji, Kodama Yuzo, Inoue Dai, Umemura Takeji, Ikeura Tsukasa, Kanno Atsushi, Iwasaki Eisuke, Fujimori Nao, Seno Hiroshi, Kikuta Kazuhiro, Nakase Hiroshi, Uehara Takeshi, Abe Shohei, Tsujimae Masahiro, Nakamura Seiji, Kawano Mitsuhiro, Masamune Atsushi
Аннотация
BACKGROUND: Immunoglobulin G4 (IgG4)-related gastrointestinal diseases (IgG4-GID) are becoming increasingly recognized. However, few cases have been reported, and the disease concept is not yet well established. This study aimed to elucidate the clinical features of IgG4-GID.
METHODS: This nationwide multicenter retrospective study collected 37 cases of IgG4-GID, which were classified and analyzed based on the pathological findings and the presence or absence of IgG4-related diseases in other organs. The pathological possibility of IgG4-GID was classified as definite, highly likely, probable, or unlikely based on the presence of typical pathological findings, number of IgG4-positive cells, and adequacy of histological evaluation.
RESULTS: Thirteen patients were classified as unlikely to undergo pathological evaluation. Among the remaining 24 cases, 20 had other organ involvement (pathologically definite, n = 8; highly likely, n = 6; probably, n = 6). The four cases without the involvement of other organs were classified as definite. After defining definite and highly likely cases, 18 cases of IgG4-GID were identified. The most commonly affected organs were the stomach (n = 12) and the duodenum (n = 6), with one case involving both. Endoscopic findings most frequently showed ulcers (n = 7), followed by submucosal tumor (SMT)-like morphology (n = 6). Treatments included surgery (n = 8; SMT-like cases), steroids (n = 2), and proton pump inhibitors or potassium-competitive acid blockers (n = 3), with all cases showing improvement.
CONCLUSIONS: IgG4-GID exhibits characteristic pathological findings and various endoscopic features. Although many patients respond to treatment, some undergo surgery; thus, increased awareness may help avoid unnecessary surgeries.
METHODS: This nationwide multicenter retrospective study collected 37 cases of IgG4-GID, which were classified and analyzed based on the pathological findings and the presence or absence of IgG4-related diseases in other organs. The pathological possibility of IgG4-GID was classified as definite, highly likely, probable, or unlikely based on the presence of typical pathological findings, number of IgG4-positive cells, and adequacy of histological evaluation.
RESULTS: Thirteen patients were classified as unlikely to undergo pathological evaluation. Among the remaining 24 cases, 20 had other organ involvement (pathologically definite, n = 8; highly likely, n = 6; probably, n = 6). The four cases without the involvement of other organs were classified as definite. After defining definite and highly likely cases, 18 cases of IgG4-GID were identified. The most commonly affected organs were the stomach (n = 12) and the duodenum (n = 6), with one case involving both. Endoscopic findings most frequently showed ulcers (n = 7), followed by submucosal tumor (SMT)-like morphology (n = 6). Treatments included surgery (n = 8; SMT-like cases), steroids (n = 2), and proton pump inhibitors or potassium-competitive acid blockers (n = 3), with all cases showing improvement.
CONCLUSIONS: IgG4-GID exhibits characteristic pathological findings and various endoscopic features. Although many patients respond to treatment, some undergo surgery; thus, increased awareness may help avoid unnecessary surgeries.