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Titre du document / Document title

Elevated serum IgG4 concentration in patients with primary sclerosing cholangitis

Auteur(s) / Author(s)

MENDES Flavia D. (1) ; JORGENSEN Roberta (1) ; KEACH Jill (1) ; KATZMANN Jerry A. (2) ; SMYRK Thomas (1) ; DONLINGER Jessica (1) ; CHARI Suresh (1) ; LINDOR Keith D. (1) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, ETATS-UNIS
(2) Clinical Biochemistry & Immunology, Mayo Clinic, Rochester, Minnesota, ETATS-UNIS

Résumé / Abstract

OBJECTIVES: Biliary strictures, similar to primary sclerosing cholangitis (PSC), have been reported in patients with autoimmune pancreatitis, which is characterized by elevated serum lgG4 levels and responsiveness to corticosteroids. We sought to determine the frequency of elevated lgG4 in patients with PSC and to clinically compare PSC patients with elevated and normal lgG4 levels. METHODS: We measured serum lgG4 in 127 patients with PSC and 87 patients with primary biliary cirrhosis, as disease controls. Demographic, clinical, and laboratory characteristics were compared between the PSC groups with normal and elevated lgG4 (>140 mg/dL). RESULTS: Elevated lgG4 was found in 12 PSC patients (9%) versus one PBC patient (1.1%) (p = 0.017). Patients with elevated lgG4 had higher total bilirubin (p = 0.009), alkaline phosphatase (p = 0.01), and PSC Mayo risk score (p = 0.038), and lower frequency of IBD (p < 0.0001). Importantly, the time to liver transplantation was shorter in patients with elevated lgG4 (1.7 vs 6.5 yr, p = 0.0009). The type of biliary involvement (intrahepatic, extrahepatic, or both) and pancreatic involvement were similar in both groups. CONCLUSIONS: A small proportion of PSC patients had elevated serum lgG4. In these patients parameters of liver disease severity were more pronounced and time to liver transplantation was shorter, suggesting a more severe disease course. It is possible that this subset of patients behaves similarly to autoimmune pancreatitis patients with biliary strictures, and could potentially respond to corticosteroids. Testing PSC patients for lgG4 and treating those with elevated levels with corticosteroids in clinical trials should be considered.

Revue / Journal Title

The American journal of gastroenterology    ISSN  0002-9270 

Source / Source

2006, vol. 101, no9, pp. 2070-2075 [6 page(s) (article)] (19 ref.)

Langue / Language

Anglais

Editeur / Publisher

Nature Publishing Group, Basingstoke, ROYAUME-UNI  (1954) (Revue)

Mots-clés anglais / English Keywords

Biliary tract disease

;

Digestive diseases

;

Gastroenterology

;

Sclerosing cholangitis

;

Human

;

Concentration

;

Serum

;

Mots-clés français / French Keywords

Voie biliaire pathologie

;

Appareil digestif pathologie

;

Gastroentérologie

;

Angiocholite sténosante

;

Homme

;

Concentration

;

Sérum

;

Mots-clés espagnols / Spanish Keywords

Vía biliar patología

;

Aparato digestivo patología

;

Gastroenterología

;

Angiocolitis estenosante

;

Hombre

;

Concentración

;

Suero

;

Localisation / Location

INIST-CNRS, Cote INIST : 11062, 35400013930756.0210

Nº notice refdoc (ud4) : 18154351



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