Chronic gastric ulceration: a novel manifestation of IgG4-related disease?

Bateman, A C; Sommerlad, Matthew; Underwood, Tim

doi:10.1136/jclinpath-2011-200565

Cited by 32 publications

(21 citation statements)

References 8 publications

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“…Reported gastric manifestations of IgG4-related disease have included a diffuse increase in IgG4-positive plasma cells with or without chronic ulcers, without associated subepithelial collagen. [29][30][31][32] We did identify a significant number of IgG4-positive plasma cells (100 cells per HPF; IgG4/IgG ratio of 55%) in 1 biopsy out of 23 tested. Although this patient's biopsy exceeded the IgG4/IgG ratio of 50% reportedly diagnostic of IgG4-related disease, 20 we felt that this finding was too infrequent to implicate IgG4 in the pathogenesis of collagenous gastritis.…”

Section: Discussionmentioning

confidence: 75%

Collagenous gastritis: a morphologic and immunohistochemical study of 40 patients

et al. 2015

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Collagenous gastritis is a rare condition defined histologically by a superficial subepithelial collagen layer. This study further characterizes the morphologic spectrum of collagenous gastritis by evaluating a multiinstitutional series of 40 patients (26 female and 14 male). The median age at onset was 16 years (range 3-89 years), including 24 patients (60%) under age 18. Twelve patients (30%) had associated celiac disease, collagenous sprue, or collagenous colitis. Hematoxylin and eosin slides were reviewed in biopsies from all patients and tenascin, gastrin, eotaxin, and IgG4/IgG immunohistochemical stains were applied to a subset. The distribution of subepithelial collagen favored the body/fundus in pediatric patients and the antrum in adults. There were increased surface intraepithelial lymphocytes (425 lymphocytes/100 epithelial cells) in five patients. Three of these patients had associated celiac and/or collagenous sprue/colitis, while the remaining two had increased duodenal lymphocytosis without specific etiology. An eosinophil-rich pattern (430 eosinophils/high power field) was seen in 21/40 (52%) patients. Seven patients' biopsies demonstrated atrophy of the gastric corpus mucosa. Tenascin immunohistochemistry highlighted the subepithelial collagen in all 21 specimens evaluated and was a more sensitive method of collagen detection in biopsies from two patients with subtle subepithelial collagen. No increased eotaxin expression was identified in 16 specimens evaluated. One of the twenty-three biopsies tested had increased IgG4-positive cells (100/high power field) with an IgG4/IgG ratio of 55%. In summary, collagenous gastritis presents three distinct histologic patterns including a lymphocytic gastritis-like pattern, an eosinophil-rich pattern, and an atrophic pattern. Eotaxin and IgG4 were not elevated enough to implicate these pathways in the pathogenesis. Tenascin immunohistochemistry can be used as a sensitive method of collagen detection.

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Section: Discussionmentioning

confidence: 75%

Collagenous gastritis: a morphologic and immunohistochemical study of 40 patients

et al. 2015

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“…The endoscopic features of IgG4-related gastropathy are nonspecific, although chronic gastric ulceration has been reported. 41 …”

Section: Igg4-related Diseasementioning

confidence: 97%

IgG4-related Disorders of the Gastrointestinal Tract

Lew

2013

Surgical Pathology Clinics

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“…Bateman et al [2] described a case with gastric ulcer that is refractory to proton pump inhibitors (PPI); histological examination revealed marked submucosal fibrosis, with a partly storiform pattern, associated with the mucosal ulceration. The present case showed similar manifestations, while Rollins et al [4] reported another different case with a large polypoid lesion in the gastric body.…”

Section: Discussionmentioning

confidence: 99%

“…Recent literature found that IgG4-related disease in stomach showed nonspecific clinical symptoms such as nausea, vomiting, abdominal pain, anemia, weight loss, which was also different under gastrioscopy and CT. By reviewing past papers, we could divide IgG4-related gastrointestinal disease into two categories: one is gastrointestinal ulceration showing prominent thickening of the wall of the esophagus and stomach [2,3] , with abundant infiltration of IgG4-positive plasma cells spreading submucosal, the other is an IgG4-related pseudotumor showing polypoid or mass-like lesions that occurring in gastrointestinal regions such as the stomach [4,5] , colon, and major duodenal papilla. Bateman et al [2] described a case with gastric ulcer that is refractory to proton pump inhibitors (PPI); histological examination revealed marked submucosal fibrosis, with a partly storiform pattern, associated with the mucosal ulceration.…”

Section: Discussionmentioning

confidence: 99%

Gastric ulcer caused by immunoglobulin G4-related diseases: a case report

Zheng

Xiao

et al. 2015

CRIM

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Objective: To enhance the diagnosis and treatment of Immunoglobulin G4-related gastric disease. Method:One case of IgG4-related gastric disease in our hospital was presented and analyzed.Result: Patients with IgG4-related gastric disease usually showed nonspecific clinical symptoms such as abdominal discomfort, dull pain, anorexia, nausea and vomiting, anemia, weight loss, etc. By gastroscopy, we could divide IgG4-related gastro intestinal disease into two categories: organ enlargement and ulceration, whose histopathological features consisting of abundant infiltration of IgG4 positive lymphocytes, plasma cells, formation of lymph follicle. The lesion could spreading to every layer of the stomach, nerve, minute vessels and regional lymph nodes, which only existed in stomach that were not associated with other IgG4-related diseases. The diagnosis of the disease may refer to Japanese IgG4-related disease diagnostic criteria. We should identify it to exclude gastric cancer clinically. Treatment with steroids was given priority to, and surgery could be a complementary method. Conclusion:The incidence of IgG4 related-gastric disease is rare, and it is not difficult to diagnose and treat by analysis of the limited cases. It is of utmost importance for us to raise vigilance, consider IgG4-related disease and especially to accumulate more cases, explore its pathogenesis, clinical characteristics if possible.

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Chronic gastric ulceration: a novel manifestation of IgG4-related disease?

Cited by 32 publications

References 8 publications

Collagenous gastritis: a morphologic and immunohistochemical study of 40 patients

Collagenous gastritis: a morphologic and immunohistochemical study of 40 patients

IgG4-related Disorders of the Gastrointestinal Tract

Gastric ulcer caused by immunoglobulin G4-related diseases: a case report

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