PDF(Pubmed)
Abstract：
A 20-year-old man was presented with ulcerative gastritis and duodenitis complicated by pyloric stenosis. Helicobacter pylori infection was excluded, and the lesions did not respond to treatment with proton pump inhibitors. No other parts of the intestinal tract showed signs of inflammation. Histopathological review showed signs of chronic inflammation with granuloma formation. A tentative diagnosis of isolated upper gastrointestinal (UGI) Crohn\'s disease was performed. However, additional work-up revealed significantly positive IgG4 staining as well as elevated IgG4 serum levels. Since granulomatous disease is unlikely in IgG4-related disease, an eventual diagnosis of overlapping IgG4-related disease and Crohn\'s disease (CD) was performed. Treatment with systemic steroids and anti-TNF in combination with azathioprine led to rapid symptomatic improvement. In this article, we review the available literature on IgG4-related gastroduodenitis, granulomatous gastritis, and upper GI CD. We suggest the possibility that IgG4-infiltration may be a marker of severely active inflammatory bowel disease rather than a separate disease entity.
摘要：
一名20岁男子患有溃疡性胃炎和十二指肠炎并伴有幽门狭窄。幽门螺杆菌感染被排除，并且病灶对质子泵抑制剂治疗无反应.肠道的其他部分没有显示出炎症的迹象。组织病理学检讨显示慢性炎症征象伴肉芽肿形成。对孤立性上消化道（UGI）克罗恩病进行了初步诊断。然而,额外的检查显示IgG4染色显著阳性以及IgG4血清水平升高.由于肉芽肿性疾病在IgG4相关疾病中不太可能，最终诊断为重叠IgG4相关疾病和克罗恩病(CD).全身性类固醇和抗TNF与硫唑嘌呤联合治疗导致症状迅速改善。在这篇文章中,我们回顾了有关IgG4相关性胃十二指肠炎的现有文献，肉芽肿性胃炎,和上消化道CD。我们建议IgG4浸润可能是严重活动性炎症性肠病的标志物，而不是单独的疾病实体。
