A case of immune checkpoint <scp>inhibitor‐associated</scp> gastroenteritis detected by ultrasonography

Omotehara, Satomi; Nishida, Mutsumi; Yamanashi, Katsuma; Sakurai, Kensuke; Katsurada, Takehiko; Shimizu, Ai; Shibuya, Hitoshi; Shinagawa, Naofumi; Sato, Junichi; Teshima, Takanori

doi:10.1002/jcu.22975

Cited by 7 publications

(6 citation statements)

References 27 publications

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“…Furthermore, there were some patients in whom a large amount of whitish purulent discharge covered the mucosal surface, resulting in pseudo-membranous formation. This appearance was described as “fibrin-covered superficial erosions” in a previous report involving endoscopic evaluation of gastrointestinal toxicity 15 16 24 . Finally, the third finding was quite characteristic as well.…”

Section: Discussionmentioning

confidence: 88%

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Severe immune checkpoint inhibitor-associated gastritis: A case series and literature review

et al. 2022

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Background and study aims Recent advances in cancer treatment have involved the clinical application of immune checkpoint inhibitors (ICIs) for various type of cancers. The adverse events associated with ICIs are generally referred to as immune-related adverse events (irAEs). Gastrointestinal irAEs are a major disorder, but gastritis is not frequently observed. The aims of this study were to elucidate the clinical, endoscopic, and histological characteristics of irAE gastritis. Patients and methods Information on patients treated with ICIs were collected from a single institute over 3 years. IrAE gastritis was identified based on the clinical course and endoscopic and histopathological findings. Of the 359 patients treated with ICIs, four cases of irAE gastritis were identified in clinical records from the endoscopy unit. The endoscopic and histopathological findings were analyzed, and further immunohistochemical studies with immune subtype markers and programmed cell death ligand-1 (PD-L1) antibody were conducted. Results Among four patients with irAE gastritis, the remarkable endoscopic characteristics were network-pattern erosion, erythematous and edematous mucosa with thick purulent discharge, and fragile mucosa. Corresponding histological features were fibrinopurulent exudate, severe inflammatory cell infiltration, and epithalaxia, respectively. The PD-L1 expression rate was ≥ 1 % in the gastric tissue of all patients with gastritis. These patients were treated with prednisolone (PSL) and their symptoms improved within a few days to 2 weeks. Conclusions IrAE gastritis were characterized by specific endoscopic findings. The appropriate endoscopic diagnosis may lead to effective treatment with PSL.

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Section: Discussionmentioning

confidence: 88%

“…The number of reported cases of severe irAE gastritis has been increasing in recent years [15][16][17][18][19][20]. Previously reported cases with severe irAE gastritis are summarized in ▶ Table 3.…”

Section: Discussionmentioning

confidence: 99%

Severe immune checkpoint inhibitor-associated gastritis: A case series and literature review

et al. 2022

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“…Table 2 presents the baseline demographics, diagnostic findings, and chief features of IMG from the individual cases ( n =24) 10,11,19–33. The median age of the included cases was 53.5 years old, and there was no difference in distribution with regard to sex.…”

Section: Resultsmentioning

confidence: 99%

“…14 Table 2 presents the baseline demographics, diagnostic findings, and chief features of IMG from the individual cases (n = 24). 10,11,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] The median age of the included cases was 53.5 years old, and there was no difference in distribution with regard to sex. 58.3% had melanoma as underlying malignancy, followed by lung cancer (25.0%).…”

Section: Description Of Included Studiesmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Gastritis Associated With Immune Checkpoint Inhibitors: Scoping Review

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Silangcruz

Kozai

et al. 2022

Journal of Immunotherapy

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Among immune-related adverse events associated with immune checkpoint inhibitors, immune-mediated gastritis (IMG) has been rarely described in the literature and has not yet been well characterized. This scoping review aimed to characterize IMG in terms of precipitating agents, clinical presentations, and prognosis. After the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including "gastritis," "immune checkpoint inhibitor," and "immune-related adverse event" from their inception to December 28, 2021. Twenty-two articles, including 5 observational studies and 17 case reports and case series, were included. Nivolumab, pembrolizumab, and combination therapy with those and cytotoxic T-lymphocyte-associated antigen-4 inhibitor (ipilimumab) were commonly used in those with IMG. 59.8% had epigastric pain, and 50% had erosive gastritis. 87.5% had Common Terminology Criteria for Adverse Events (CTCAE) grade 3 gastritis, and 91.2% received corticosteroids. Recurrence was noted in 16.7%, and only 1 expiration was noted. 4.3% had positive helicobacter pylori and cytomegalovirus from the gastric specimen. Similar to immunerelated colitis, patients with IMG may have a favorable prognosis with a better response to immune checkpoint inhibitors if treated appropriately. The diagnosis of IMG is made by exclusion, and a thorough workup is necessary to rule out concurrent helicobacter pylori and cytomegalovirus involvement. Further studies are critical for a better understanding of this complication.

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“…The macroscopic appearance in those cases was described similarly to our case and other cases without CMV detection, but the treatment is significantly different, obviously. Some cases mentioned a different anatomical distribution of the affected tissues without the gastric mucosa being the affected area only; in one case study, the transverse colon was affected by the irAE with diffuse erythema and oedema [16]. Another case is described with an affected duodenum leading to gastroduodenitis associated with pembrolizumab [27].…”

Section: Discussionmentioning

confidence: 99%

Immune-mediated Gastritis in a Patient with metastatic Lung Cancer due to Therapy with the immune Checkpoint Inhibitor Pembrolizumab – Differences and Similarities in Comparison to “endogenous” autoimmune Type A Gastritis and a review of literature

2023

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Immune checkpoint inhibitors are increasingly used in advanced malignant diseases and are well-known for their good results. With the blockade of immune checkpoints, the probability of immune-related adverse events is also increased.We present a 54-year-old female patient with advanced NSCLC. She was treated with pembrolizumab and developed a stable disease under therapy. After six cycles, she presented with massive epigastric pain to our emergency department. Gastroscopy showed severe erosive-fibrinous pangastritis without the involvement of the esophagus, duodenum, or other immune-related adverse effects. Histology showed the complete destruction of the gastric mucosa. We concluded an immune-mediated gastritis by pembrolizumab, after the exclusion of other differential diagnoses.Despite treatment with prednisolone and marked improvement of her symptoms, the mucosa was never fully reconstituted into a healthy mucosa.Furthermore, we collected published reports of similar cases and conducted a comparison with features of a typical, endogenous type A gastritis to highlight similarities and differences.

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A case of immune checkpoint inhibitor‐associated gastroenteritis detected by ultrasonography

Cited by 7 publications

References 27 publications

Severe immune checkpoint inhibitor-associated gastritis: A case series and literature review

Severe immune checkpoint inhibitor-associated gastritis: A case series and literature review

Clinical Characteristics and Outcomes of Gastritis Associated With Immune Checkpoint Inhibitors: Scoping Review

Immune-mediated Gastritis in a Patient with metastatic Lung Cancer due to Therapy with the immune Checkpoint Inhibitor Pembrolizumab – Differences and Similarities in Comparison to “endogenous” autoimmune Type A Gastritis and a review of literature

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