“Stardust” Gastric Mucosa in the Course of Immune Checkpoint Inhibitor-Associated Gastritis

Okamoto, Akino; Yoshii, Shunsuke; Tsujii, Yoshiki; Hayashi, Yoshito; Shinzaki, Shinichiro; Takehara, Tetsuo

doi:10.14309/ajg.0000000000001835

Cited by 3 publications

(2 citation statements)

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“…Of these immune-related adverse events (irAEs), enterocolitis is one of the most frequent and severe, causing abdominal pain and/or diarrhea that can be life-threatening. 1,2 There are scarce data about gastrointestinal (GI) irAEs involving the upper GI tract, limited to case reports [3][4][5][6][7][8][9][10][11][12][13][14][15][16] and a few small series. [17][18][19][20][21][22] In earlier retrospective cohorts of 41 and 80 patients with GI-related irAEs, gastritis represented only approximately 5% of all GI luminal irAEs.…”

Section: Introductionmentioning

confidence: 99%

Immune checkpoint inhibitor gastritis is often associated with concomitant enterocolitis, which impacts the clinical course

Haryal

Townsend

Baskaran

et al. 2022

Cancer

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Background Gastrointestinal immune‐related adverse events are frequently caused by immune checkpoint inhibitors (ICIs) and often require interruption of cancer treatment. Compared with ICI colitis and enteritis, limited information exists about ICI gastritis. This study characterized clinical features and treatment outcomes of ICI gastritis. Methods Consecutive cancer patients who received ICIs and underwent endoscopy with gastric biopsies while on ICIs from 2011 to 2021 were retrospectively assessed. Specific histopathologic features identified ICI gastritis. Results Of 6450 ICI‐treated patients, 162 (2.5%) underwent endoscopy with gastric biopsies. ICI gastritis was identified in 54 (33%) biopsied patients; 38 (70%) had concurrent ICI enteritis/colitis and 16 (30%) had isolated ICI gastritis. Dyspepsia (38%) and bloating (25%) were the most frequent symptoms of isolated ICI gastritis. Compared with patients with concomitant enteritis/colitis, patients with isolated gastritis were less likely to have diarrhea (13% vs 68%; p < .001) or abdominal pain (19% vs 47%; p = .07). Patients with isolated ICI gastritis less frequently required glucocorticoids (69% vs 92%; p = .04) and had lower incidence of ICI hold/withdrawal (13% vs 42%; p = .06). There was no association between severity or extent of luminal inflammation and antitumor response (p = .85 and p = .44, respectively). Endoscopically, gastric mucosa appeared normal in 11 (20%) patients with biopsy‐proven ICI gastritis. Conclusion ICI gastritis may present alone or more commonly with concurrent enteritis/colitis, which may differentiate its clinical course. Gastric biopsies are required to diagnose a substantial minority of endoscopically normal, clinically significant cases. Most patients with isolated gastritis can continue ICI therapy uninterrupted, but a notable proportion require glucocorticoids. Plain language summary Immune checkpoint inhibitors are effective anticancer treatments, but can cause inflammatory toxicities, including of the stomach (gastritis), intestine, and colon. Limited information is available on gastritis triggered by these agents. Adult patients with cancer who were treated with immune checkpoint inhibitors and had an upper gastrointestinal endoscopy with biopsies of the stomach were examined. More than two‐thirds (70%) of people with checkpoint inhibitor gastritis also had inflammatory changes of the small intestine and/or colon. Compared with patients with isolated checkpoint gastritis, the subgroup with concomitant enteritis/colitis more frequently had abdominal pain, diarrhea, needed steroids, and/or needed to pause or stop antitumor therapy.

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Section: Introductionmentioning

confidence: 99%

Immune checkpoint inhibitor gastritis is often associated with concomitant enterocolitis, which impacts the clinical course

Haryal

Townsend

Baskaran

et al. 2022

Cancer

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“…Upper gastrointestinal tract conditions including oesophagitis, [131][132][133][134][135][136][137] oesophagitis dissecans superficialis, 138 oesophageal stenosis, 139 gastritis, [140][141][142][143][144][145][146][147][148][149][150][151][152][153][154][155][156] gastroparesis and enteric neuropathy, 157-160 enteritis (discussed above) and coeliac disease [161][162][163] have been reported in association with ICI use. Data are largely limited to case reports and small series, and oncology society guidelines do not detail algorithmic management.…”

Section: Other G a S Trointe S Tinal Toxicitie S: Oe Sophag Itis G A...mentioning

confidence: 99%

Review article: Contemporary management of gastrointestinal, pancreatic and hepatic toxicities of immune checkpoint inhibitors

Townsend,

Benque,

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundImmune checkpoint inhibitors (ICIs) are effective oncologic agents which frequently cause immune‐related adverse events (irAEs) which can impact multiple organ systems. Onco‐Gastroenterology is a novel and emerging subspecialty within gastroenterology focused on cancer treatment‐related complications. Gastroenterologists must be prepared to identify and manage diverse immune‐mediated toxicities including enterocolitis, hepatitis, pancreatitis and other ICI‐induced toxicities.AimTo provide a narrative review of the epidemiology, diagnostic evaluation and management of checkpoint inhibitor‐induced gastrointestinal and hepatic toxicities.MethodsWe searched Cochrane and PubMed databases for articles published through August 2023.ResultsGastrointestinal and hepatic irAEs include most commonly enterocolitis and hepatitis, but also pancreatitis, oesophagitis, gastritis, motility disorders (gastroparesis) and other rarer toxicities. Guidelines from the National Comprehensive Cancer Network, American Society of Clinical Oncology and European Society for Medical Oncology, in combination with emerging cohort and clinical trial data, offer strategies for management of ICI toxicities. Evaluation of irAEs severity by formal classification and clinical stability, and a thorough workup for alternative etiologies which may clinically mimic irAEs underlie initial management. Treatments include corticosteroids, biologics and other immunosuppressive agents plus supportive care; decisions on dosing, timing and choice of steroid adjuncts and potential for subsequent checkpoint inhibitor dosing are nuanced and toxicity‐specific.ConclusionsExpanding clinical trial and cohort data have clarified the epidemiology and clinical characteristics of gastrointestinal, pancreatic and hepatic toxicities of ICIs. Guidelines, though valuable, remain based principally on retrospective cohort data. Quality prospective, controlled studies may refine algorithms for treatment and potential immunotherapy rechallenge.

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A systematic review of gastritis as an immune-related adverse event in clinical interventions

Su,

Fan,

Zhang

et al. 2024

Human Vaccines & Immunotherapeutics

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Immune checkpoint inhibitors (ICIs) are crucial in cancer treatment, and the associated immune-related adverse events (irAEs) have garnered significant attention, yet reports on associated immune related gastritis are limited. The diagnosis of immune related gastritis remains predominantly exclusionary, meanwhile its management diverges significantly from that of conventional gastritis. Current guidelines lack standardized grading criteria, and substantial data from large-scale, tertiary clinical studies are absent, therefore we conducted a systematic review of Medline, Web of Science, and Embase databases, identifying 31 articles from 2017 to December 31, 2023, involving 258 patients. Clinical manifestations included epigastric pain (53.1%), mucosal erythema (56.1%), and lymphocyte infiltration (48.6%). Corticosteroid therapy was common (94.7%), with 86.7% experiencing post-treatment improvement. 80% of patients can be diagnosed through endoscopy and pathology, while the remaining 20% may require PET-CT. Hormonal therapy is favored but diverges from standard management. Accurate diagnosis is crucial in managing immune related gastritis effectively.

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“Stardust” Gastric Mucosa in the Course of Immune Checkpoint Inhibitor-Associated Gastritis

Cited by 3 publications

References 0 publications

Immune checkpoint inhibitor gastritis is often associated with concomitant enterocolitis, which impacts the clinical course

Immune checkpoint inhibitor gastritis is often associated with concomitant enterocolitis, which impacts the clinical course

Review article: Contemporary management of gastrointestinal, pancreatic and hepatic toxicities of immune checkpoint inhibitors

A systematic review of gastritis as an immune-related adverse event in clinical interventions

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