Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan.
Scand J Gastroenterol. 2021 Dec;56(12):1456-1461. doi: 10.1080/00365521.2021.1971758. Epub 2021 Sep 5.
Gallbladder (GB) wall thickening sometimes occurs in patients with autoimmune pancreatitis (AIP), a condition for which the name, IgG4-related cholecystitis, was proposed. We examined the radiological findings of the GB in patients with IgG4-related diseases and clinical features of patients with GB wall thickening and presented a hypothesis of its pathogenesis.
GB wall thickening was defined by thickness ≥ 4 mm. GB wall thickness was examined in 258 patients with IgG4-related disease. Clinical and imaging findings of 200 patients with AIP with and without GB wall thickening were then compared.
GB wall thickening was detected in 58 patients (29%) with AIP and two patients with isolated IgG4-related sclerosing cholangitis. In the 60 GBs examined, wall thickening was diffuse, with the walls possessing a smooth inner surface. No GB wall thickening was detected among the 56 patients with IgG4-related disease without AIP or IgG4-related sclerosing cholangitis. Bile duct stenosis was detected in 56 patients (97%) with AIP with GB wall thickening. Intraductal ultrasonography indicated cystic duct wall thickening connected to bile duct wall thickening in 11 of 14 (79%) patients with AIP or IgG4-related sclerosing cholangitis with GB wall thickening. Forty-eight patients in whom IgG4-related cholecystitis was diagnosed experienced resolution of the GB wall thickening after receiving steroid therapy.
Most cases of GB wall thickening in IgG4-related diseases are closely associated with IgG4-related sclerosing cholangitis and may be a manifestation of IgG4-related disease throughout the biliary tract, including the bile duct, cystic duct, and GB.
胆囊（GB）壁增厚有时发生在自身免疫性胰腺炎（AIP）患者中，为此提出了 IgG4 相关胆囊炎的名称。我们检查了 IgG4 相关疾病患者的 GB 放射学发现，并提出了其发病机制的假说。
GB 壁增厚定义为厚度≥4mm。检查了 258 例 IgG4 相关疾病患者的 GB 壁厚度。然后比较了 200 例有和无 GB 壁增厚的 AIP 患者的临床和影像学表现。
在 58 例 AIP 患者（29%）和 2 例孤立性 IgG4 相关硬化性胆管炎患者中发现了 GB 壁增厚。在检查的 60 个 GB 中，壁增厚是弥漫性的，壁内表面光滑。在没有 AIP 或 IgG4 相关硬化性胆管炎的 56 例 IgG4 相关疾病患者中未发现 GB 壁增厚。在有 GB 壁增厚的 56 例 AIP 患者中，胆管狭窄检出率为 97%。在 14 例（79%）有 GB 壁增厚的 AIP 或 IgG4 相关硬化性胆管炎患者中，经腔内超声检查发现胆囊管壁增厚与胆管壁增厚相连。在诊断为 IgG4 相关胆囊炎的 48 例患者中，接受类固醇治疗后，GB 壁增厚得到缓解。
IgG4 相关疾病中大多数 GB 壁增厚与 IgG4 相关硬化性胆管炎密切相关，可能是整个胆道包括胆管、胆囊管和胆囊的 IgG4 相关疾病的表现。
