Can IgG4 Levels Identify the Ulcerative Colitis Subtype of Inflammatory Bowel Disease?

Abstract

BackgroundPancreatitis and exocrine pancreatic insufficiency may occur as extraintestinal manifestations of inflammatory bowel disease. Recently, autoimmune pancreatitis and colitis have been described as presentations of IgG4-related disease. IgG4+ plasma cells have been identified in colon tissue from patients with refractory forms of inflammatory bowel disease. The presence of elevated serum/tissue levels of IgG4 and the frequency of exocrine pancreatic insufficiency in inflammatory bowel disease are still a source of controversy. Our aim was to investigate the meaning of elevated IgG4 levels in patients with inflammatory bowel disease.MethodsA cross-sectional study analyzed 56 patients with a diagnosis of inflammatory bowel disease recruited by convenience sampling from two tertiary centers in Midwestern Brazil. All patients underwent fecal pancreatic elastase testing for detection of exocrine pancreatic insufficiency and serum IgG4 measurement. Findings were correlated with clinical and epidemiological data and disease activity.ResultsElevated serum IgG4 levels were found in 10 patients, and were most frequent in ulcerative colitis (nine cases), with a prevalence ratio of 16.42 (95% CI: 3.32 - 79.58). Ten patients (10 of 56, 17.8%) were diagnosed with exocrine pancreatic insufficiency, which did not correlate with disease activity, and serum IgG4 levels.ConclusionExocrine pancreatic insufficiency is prevalent in patients with inflammatory bowel disease, but it is not associated with elevated serum IgG4 levels. The high prevalence of elevated serum IgG4 in ulcerative colitis suggests that this parameter has potential for use as a diagnostic biomarker.

Utility of gastric biopsy in diagnosing IgG4‐related gastrointestinal disease

“…As a matter of fact, most cases of IgG4‐GID do not exhibit other organ involvement as observed in IgG4‐RD cases; thus, it is unlikely that all these cases represent genuine IgG4‐GID. Especially, the infiltration of IgG4‐positive plasma cells has also been shown in several IgG4‐unrelated GI diseases including inflammatory bowel disease, celiac disease, Rosai–Dorfman disease, and Cronkhite–Canada syndrome 35–37 . Storiform fibrosis and obliterative phlebitis are helpful histological features for diagnosing IgG4‐RD, but they are not commonly found in reported IgG4‐GID cases.…”

IgG4-related disease as a rare cause of gastric outlet obstruction: a case report and literature review

“…On one hand, given the context, colitis secondary to IgG4-RD is very plausible. On the other hand, IgG4-positive plasma cells are commonly seen in IBD, especially ulcerative colitis [ 32 , 33 ]. Therefore, the etiology and significance of the inflammation seen on colonoscopy remains to be determined.…”

Hepatobiliar manifestations in inflammatory bowel disease: A practical approach

“…Age of onset is (50-60)’s, predominately men. 75% PSC-patients have underlying IBD compare to IgG4 cholangitis in which case only 5% develops IBD[ 28 ]. IgG4+ plasma cells have been identified in colon tissue from patients with refractory forms of IBD patients.…”