Journal of Gastrointestinal & Digestive System
Open Access

Case Report

Gastric Ulcer: An Old Disease - A New Cause

Silke Urban^1*, 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
Switzerland
Tel: 0041 61 685 8585
Fax: 0041 61 685 8182
E-mail: Silke.Urban@claraspital.ch

Received date: October 22, 2014; Accepted date: November 24, 2014; Published date: 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.

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 disease.
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.

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