1
|
Poole H, Fehily S, McKelvie P, Miller A, Lust M, Holmes JA. Isolated esophageal IgG4-related disease presenting with progressive dysphagia and weight loss in a middle-aged man. Clin J Gastroenterol 2022; 15:526-530. [PMID: 35381953 DOI: 10.1007/s12328-022-01623-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognized immune-mediated condition that results in inflammation, stricturing and mass formation. It causes a wide spectrum of disease and clinical presentations depending on the organ system involved. Isolated esophageal IgG4-RD is rare and diagnosis can be difficult. It is highly responsive to corticosteroids, and early identification and instigation of management is key.We describe the case of a 47-year-old man who presented with a food bolus obstruction on a background of progressive dysphagia and weight loss. Imaging and gastroscopy demonstrated diffuse esophageal thickening with a benign appearing stricture. Following non-specific histologic findings on biopsy and a non-diagnostic endoscopic ultrasound guided fine needle aspiration, he underwent video-assisted thoracoscopic surgery with esophageal core biopsy. This confirmed the diagnosis of IgG4-RD. Initial treatment was with corticosteroids. However, due to recurrence of symptoms upon weaning of corticosteroids, azathioprine maintenance therapy was instituted. Azathioprine has previously been used in systemic cases of IgG4-RD but has not been reported for isolated esophageal disease.This case highlights the difficulties in the diagnosis and treatment of esophageal IgG4-RD and the need to consider it as a differential diagnosis when histology reveals esophagitis with lymphoplasmacytic infiltration.
Collapse
Affiliation(s)
- Hannah Poole
- St Vincent's Hospital Melbourne, 40 Victoria Pde, Fitzroy, VIC 3065, Australia.
| | - Sasha Fehily
- Department of Gastroenterology, St Vincent's Hospital Melbourne, 40 Victoria Pde, Fitzroy, VIC 3065, Australia
| | - Penelope McKelvie
- Anatomical Pathology, St Vincent's Hospital Melbourne, 40 Victoria Pde, Fitzroy, VIC 3065, Australia.,Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Ashley Miller
- St Vincent's Hospital Melbourne, 40 Victoria Pde, Fitzroy, VIC 3065, Australia
| | - Mark Lust
- Department of Gastroenterology, St Vincent's Hospital Melbourne, 40 Victoria Pde, Fitzroy, VIC 3065, Australia
| | - Jacinta Alison Holmes
- Department of Gastroenterology, St Vincent's Hospital Melbourne, 40 Victoria Pde, Fitzroy, VIC 3065, Australia.,University of Melbourne, Melbourne, Australia
| |
Collapse
|
2
|
Trakman GL, Fehily S, Basnayake C, Hamilton AL, Russell E, Wilson-O'Brien A, Kamm MA. Diet and gut microbiome in gastrointestinal disease. J Gastroenterol Hepatol 2022; 37:237-245. [PMID: 34716949 DOI: 10.1111/jgh.15728] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 12/20/2022]
Abstract
The composition and function of the dynamic microbial community that constitutes the gut microbiome is continuously shaped by the host genome, mode of birth delivery, geography, life stage, antibiotic consumption, and diet. Diet is one of the most potent factors in determining microbiome integrity. Dietary factors in early life appear to substantially determine the risk of later health or disease; for example, exposure to ultra-processed foods in childhood or adolescence may increase the risk of the later development of inflammatory bowel disease or colorectal cancer, thought to be mediated by modulation of the gut microbiota. Dietary factors when gut diseases are established influence symptoms and disease activity, can form a risk factor for ongoing disease, or can be used as therapy to decrease disease activity. The characterization of dietary content is currently complex and imperfect, but tools are emerging to define precisely the nature of dietary composition. Similarly, the revolution in microbial analysis allows greater understanding of how diet influences microbial composition and function. Defining the interaction between diet, the gut microbiome, and gastrointestinal disease is leading to radical changes in our clinical approach to these disorders.
Collapse
Affiliation(s)
- Gina L Trakman
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Dietetics, Human Nutrition and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Sasha Fehily
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Chamara Basnayake
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Amy L Hamilton
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Erin Russell
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Amy Wilson-O'Brien
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Michael A Kamm
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Tsoi EH, Fehily S, Williams R, Desmond P, Taylor A. Diffuse endoscopically visible, predominantly low grade dysplasia in Barrett's esophagus (with video). Endosc Int Open 2019; 7:E1742-E1747. [PMID: 31828211 PMCID: PMC6904234 DOI: 10.1055/a-1031-9327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022] Open
Abstract
Background Low grade dysplasia (LGD) in Barrett's esophagus (BE) has generally been considered as undetectable endoscopically. Aim To describe a phenotype which consists of diffuse, endoscopically visible, predominantly low grade dysplasia in Barrett's esophagus (DEVLB), with often subtle but visible endoscopic changes seen with high definition white light (HDWL) and narrow-band imaging (NBI). Method A systematic search of a prospectively collected database for patients satisfying predefined criteria for DEVLB and a review of endoscopic and histological features of biopsies and endoscopic mucosal resection (EMR) specimens. Results Out of a total of 419 patients referred to our expert center for assessment of dysplastic Barrett's esophagus during the period January 2009 to March 2018, there were 7 patients (1.7 %) who satisfied the criteria defined for DEVLB, identified on their initial assessment endoscopy. All patients were treated by EMR of visible abnormal mucosa during their assessment endoscopy at our tertiary referral center. There was a total of 47 EMR specimens obtained, with a median of 6 (IQR 5-9) EMR resection pieces per patient, of which 36 (77 %) contained LGD, 8 (17 %) high grade dysplasia (HGD), 2 (4 %) non-dysplastic Barrett's esophagus (NDBE), and 1 (2 %) contained early esophageal adenocarcinoma (EAC). Conclusion DEVLB is a distinct phenotype seen in a small but significant proportion of individuals with dysplastic Barrett's esophagus. Patients with DEVLB have widespread LGD, with many having areas of focal HGD or early cancer within this area. We believe these patients are best treated with extensive EMR of the visibly abnormal area.
Collapse
Affiliation(s)
- Edward H. Tsoi
- St. Vincent’s Hospital, Department of Gastroenterology, Fitzroy, Victoria, Australia,University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Victoria, Australia,Corresponding author Dr. Edward H. Tsoi, MBBS MPH FRACP St. Vincent’s Hospital Melbourne41 Victoria ParadeFitzroy 3065VictoriaAustralia+61-3-86486318
| | - Sasha Fehily
- St. Vincent’s Hospital, Department of Gastroenterology, Fitzroy, Victoria, Australia
| | - Richard Williams
- St. Vincent’s Hospital, Department of Pathology, Fitzroy, Victoria, Australia
| | - Paul Desmond
- St. Vincent’s Hospital, Department of Gastroenterology, Fitzroy, Victoria, Australia,University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Victoria, Australia
| | - Andrew Taylor
- St. Vincent’s Hospital, Department of Gastroenterology, Fitzroy, Victoria, Australia,University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Victoria, Australia
| |
Collapse
|
4
|
Fehily S, Blashki G, Judd F, Piterman L, Yang H. Case studies in mental health in general practice: depression and malignancy. Fam Med Community Health 2013. [DOI: 10.15212/fmch.2013.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|