Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI.
Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY.
J Immunother. 2022 Oct 1;45(8):363-369. doi: 10.1097/CJI.0000000000000435. Epub 2022 Aug 16.
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 immune-related 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.
在与免疫检查点抑制剂相关的免疫相关不良事件中，免疫介导性胃炎 (IMG) 在文献中很少被描述，尚未得到很好的描述。本范围综述旨在描述 IMG 在诱发因素、临床表现和预后方面的特征。根据系统评价和荟萃分析扩展的首选报告项目，我们使用包括“胃炎”、“免疫检查点抑制剂”和“免疫相关不良事件”在内的关键词，从其开始到 2021 年 12 月 28 日，在 MEDLINE 和 EMBASE 中搜索所有同行评议的文章。共纳入 22 篇文章，包括 5 项观察性研究和 17 项病例报告和病例系列研究。nivolumab、pembrolizumab 以及这些药物与细胞毒性 T 淋巴细胞相关抗原 4 抑制剂（ipilimumab）的联合治疗在 IMG 患者中常用。59.8%有上腹痛，50%有糜烂性胃炎。87.5%有不良事件通用术语标准 (CTCAE) 3 级胃炎，91.2%接受皮质类固醇治疗。16.7%的患者有复发，只有 1 例死亡。胃标本中 4.3%有幽门螺杆菌和巨细胞病毒阳性。与免疫相关性结肠炎类似，如果适当治疗，IMG 患者可能有较好的预后，对免疫检查点抑制剂的反应更好。IM 的诊断是通过排除性诊断得出的，需要进行彻底的检查以排除同时存在的幽门螺杆菌和巨细胞病毒感染。进一步的研究对于更好地理解这种并发症至关重要。
