|Silke Urban1*, Michael Manz1, Andreas Zettl2, Thomas Peters3, Katrin Baumann4 and Markus von Flüe1|
|1Gastrointestinal Unit , St. Claraspital Basel, Switzerland|
|2Department of Pathology Viollier AG, Switzerland|
|3Department of Endocrinology St. Claraspital Basel, Switzerland|
|4GP surgery Dr. K. Baumann Muttenz, Switzerland|
|Corresponding Author :||Silke Urban
GI Unit, St. Claraspital Basel
Tel: 0041 61 685 8585
Fax: 0041 61 685 8182
|Received October 22, 2014; Accepted November 24, 2014; Published November 29, 2014|
|Citation: Urban S, Manz M, Zettl A, Peters T, Baumann K, et al. (2014) Gastric Ulcer: An Old Disease - A New Cause . J Gastrointest Dig Syst 4:241. doi:10.4172/2161-069X.1000241|
|Copyright: © 2014 Urban S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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A 73 year patient presented with melena to our endoscopy unit. He was hemodynamically stable and the
haemoglobin was decreased with 113 g/l. The remaining blood tests were normal. Upper endoscopy showed a large
bleeding ulcer along the lesser curvature, macroscopically suspicious for malignancy. To control the bleeding and to
rule out gastric cancer, the patient was referred to surgery. Two thirds of the stomach, a segment of the transverse
colon with mesocolon had to be resected en bloc. Final histology revealed a chronic ventricular ulcer with a distinct
lymphofollicular, lymphoplasmacellular and eosinophilic inflammation. The number of IgG4 plasma cells was
increased (60 IgG4 positive cells per microscopic visual field, 70-80% IgG4 out of all IgGs). Storiform fibrosis and
obliterating phlebitis were found not only within the ulcer base but also extensively in the adjacent soft tissue.
Summarizing, our patient suffered from a rare form of a chronic gastric ulceration as a manifestation of IgG4-related
IgG4-related disease is an increasingly recognized condition presenting with specific pathological, serologic and
clinical features. Its hallmark is the typical histopathological finding as in our case. Type 1 autoimmune pancreatitis
and salivary gland disease are the two typical presentations, but IgG4-disease can affect each organ.
Because of no further organ involvement, consecutive immunosuppressant treatment was not required. Seven
months later gastroscopy showed no signs of recurrence.
A gastric ulcer can be the first presentation of IgG4 related disease which needs to be considered as a differential
diagnosis in refractory gastritis and cancer suspicious lesions.
|Figure 1||Figure 2|