Department of Oncology, Affiliated Hospital of Qinghai University, Xining 810000, Qinghai Province, China.
Ying-Fang Deng and Xian-Shu Cui.
World J Gastroenterol. 2024 Sep 28;30(36):4031-4035. doi: 10.3748/wjg.v30.i36.4031.
In recent years, with the extensive application of immunotherapy in clinical practice, it has achieved encouraging therapeutic effects. While enhancing clinical efficacy, however, it can also cause autoimmune damage, triggering immune-related adverse events (irAEs). Reports of immunotherapy-induced gastritis have been increasing annually, but due to its atypical clinical symptoms, early diag-nosis poses a certain challenge. Furthermore, it can lead to severe complications such as gastric bleeding, elevating the risk of adverse outcomes for solid tumor patients if immunotherapy is interrupted. Therefore, gaining a thorough under-standing of the pathogenesis, clinical manifestations, diagnostic criteria, and treatment of immune-related gastritis is of utmost importance for early identification, diagnosis, and treatment. Additionally, the treatment of immune-related gastritis should be personalized according to the specific condition of each patient. For patients with grade 2-3 irAEs, restarting immune checkpoint inhibitors (ICIs) therapy may be considered when symptoms subside to grade 0-1. When restarting ICIs therapy, it is often recommended to use different types of ICIs. For grade 4 irAEs, permanent discontinuation of the medication is necessary.
近年来,免疫疗法在临床实践中的广泛应用取得了令人鼓舞的治疗效果。然而,在提高临床疗效的同时,它也可能导致自身免疫损伤,引发免疫相关不良事件(irAEs)。免疫疗法引起的胃炎的报告逐年增加,但由于其非典型的临床症状,早期诊断具有一定的挑战性。此外,如果中断免疫治疗,它还可能导致严重的并发症,如胃出血,从而增加实体瘤患者不良预后的风险。因此,深入了解免疫相关性胃炎的发病机制、临床表现、诊断标准和治疗方法对于早期识别、诊断和治疗至关重要。此外,免疫相关性胃炎的治疗应根据每个患者的具体情况进行个性化。对于 2-3 级 irAEs 的患者,当症状缓解至 0-1 级时,可考虑重新开始使用免疫检查点抑制剂(ICI)治疗。当重新开始 ICI 治疗时,通常建议使用不同类型的 ICI。对于 4 级 irAEs,则需要永久停止用药。