Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
J Gastroenterol Hepatol. 2022 Oct;37(10):1865-1872. doi: 10.1111/jgh.15980. Epub 2022 Aug 21.
Gastric IgG4-related disease (IgG4-RD) can mimic malignancy, submucosal tumors (SMT), and ulcers, leading to over-triage and unnecessary medical interventions such as gastrectomy. The variability in the clinicopathological presentation of IgG4-related disease is not yet well defined, posing a diagnostic challenge.
Following the PRISMA Extension for Scoping Reviews, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including "gastritis," "stomach," "gastrointestinal stromal tumor," and "IgG4-RD" from their inception to December 28, 2021.
Thirty-nine articles, including 2 observational studies and 42 cases, were included in the systematic review. While bottom-heavy lymphoplasmacytic mucosal infiltration is a characteristic finding of gastric IgG4-RD, it was only present in less than half of the patients in the observational studies. Patients with gastric IgG4-RD were more likely to be diagnosed with gastrointestinal stromal tumor (GIST), gastric cancer, or peptic ulcer disease and their clinical course involved resection (51.3%) or even gastrectomy. Diagnosis of gastric IgG4-RD was most frequently made by post-operative pathological analysis.
This systematic review summarizes the current understanding of the characteristics of gastric IgG4-RD. Increased awareness of gastric IgG4-RD as a differential diagnosis of gastric SMT or ulcers among clinicians is crucial in order to reduce unnecessary high-risk, invasive interventions.
胃 IgG4 相关疾病（IgG4-RD）可能类似于恶性肿瘤、黏膜下肿瘤（SMT）和溃疡，导致过度分诊和不必要的医疗干预，如胃切除术。IgG4 相关疾病的临床病理表现存在差异，目前尚未明确，这给诊断带来了挑战。
根据 PRISMA 扩展范围审查，我们使用包括“胃炎”、“胃”、“胃肠道间质瘤”和“IgG4-RD”在内的关键字，从其开始到 2021 年 12 月 28 日，在 MEDLINE 和 EMBASE 中搜索了所有同行评议的文章。
系统评价共纳入 39 篇文章，包括 2 项观察性研究和 42 例病例。虽然胃 IgG4-RD 的特征性表现为底部较重的淋巴浆细胞黏膜浸润，但在观察性研究中，只有不到一半的患者存在这种表现。胃 IgG4-RD 患者更可能被诊断为胃肠道间质瘤（GIST）、胃癌或消化性溃疡病，其临床过程涉及切除（51.3%）甚至胃切除术。胃 IgG4-RD 的诊断最常通过术后病理分析做出。
本系统评价总结了目前对胃 IgG4-RD 特征的认识。提高临床医生对胃 SMT 或溃疡的鉴别诊断中胃 IgG4-RD 的认识，对于减少不必要的高风险、侵入性干预至关重要。
