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IgG4+ cells are increased in the gastrointestinal tissue of pediatric patients with active eosinophilic gastritis and duodenitis and decrease in remission

  • Laura Quinn
    Correspondence
    Corresponding author: 13123 East 16th Avenue, Box 290, Aurora, CO 80045, Fax: 720-777-7277, Phone: 717-982-1165.
    Affiliations
    Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology & Nutrition, Gastrointestinal Eosinophilic Diseases Program, and the Digestive Health Institute; Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
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  • Brian Nguyen
    Affiliations
    Department of Pathology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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  • Author Footnotes
    # Authors contributed equally to this work.
    Calies Menard-Katcher
    Footnotes
    # Authors contributed equally to this work.
    Affiliations
    Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology & Nutrition, Gastrointestinal Eosinophilic Diseases Program, and the Digestive Health Institute; Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
    Search for articles by this author
  • Author Footnotes
    # Authors contributed equally to this work.
    Lisa Spencer
    Footnotes
    # Authors contributed equally to this work.
    Affiliations
    Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology & Nutrition, Gastrointestinal Eosinophilic Diseases Program, and the Digestive Health Institute; Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
    Search for articles by this author
  • Author Footnotes
    # Authors contributed equally to this work.
Published:September 02, 2022DOI:https://doi.org/10.1016/j.dld.2022.08.020

      Abstract

      Background

      Recent studies have shown that IgG4 is increased in the esophageal tissue of eosinophilic esophagitis patients, including the presence of IgG4+ plasma cells.

      Aims

      Our aim was to determine whether IgG4 is elevated in the gastric or duodenal tissue of pediatric patients with eosinophilic gastritis or duodenitis (EoG or EoD).

      Methods

      This was a retrospective single center study. Pediatric patients were characterized as having active EoG, EoD, or as controls based on clinical symptoms and histologic features. Immunohistochemistry for IgG4 was performed in gastric and duodenal tissue, and peak IgG4+ cells were compared between groups and after treatment.

      Results

      The frequency of IgG4+ cells was significantly higher in patients with EoG and EoD compared to controls in the stomach [EoG 6.5 cells/hpf (3.6-10.9), control 0 cells/hpf (0-0.7), p<0.0001] and duodenum [EoD 7.5 cells/hpf (2.8-37), control 0.5 cells/hpf (0.3-1.3), p<0.001)] respectively, and positively correlated with eosinophil counts (stomach: r 0.74, p<0.0001; duodenum: r 0.57, p<0.0001). The amount of tissue IgG4 was significantly decreased in patients in remission but not in persistently active disease.

      Conclusions

      These data suggest local tissue production of IgG4 may be a universal feature of eosinophilic gastrointestinal disease that tracks with disease activity.

      Key words

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