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Elevated immunoglobulin G4 level is associated with reduced colectomy-free survival in patients with primary sclerosing cholangitis and ulcerative colitis.
MedLine Citation:
PMID:  22554774     Owner:  NLM     Status:  Publisher    
BACKGROUND AND AIM: Patients with primary sclerosing cholangitis (PSC) and elevated immunoglobulin (Ig) G4 have been shown to have more severe disease with a shorter time to orthotopic liver transplantation (OLT). The aim of the study was to investigate the clinical outcomes of PSC and UC in patients with elevated serum IgG4. METHODS: We analyzed data from 50 patients with PSC and known serum levels of IgG4. They were divided into groups called high IgG4 (>112IU/L; n=10) or normal IgG4 (n=40). We compared the requirement of OLT and colectomy between groups. RESULTS: High IgG4 was found in 10 PSC patients (20%). UC was associated in 9/10 patients with high IgG4 vs. 32/40 patients with normal IgG4 (p=0.67). Patients with high IgG4 were younger at PSC diagnosis (28.1±13.9 vs. 37.6±13.4years, P=0.04), more likely to have backwash ileitis (7/9 vs. 12/32, P<0.001) and UC flares (median of 5.5 vs. 1.5, P=0.02). Kaplan-Meier curve analysis showed that patients with elevated IgG4 had reduced colectomy-free survival than patients with normal IgG4 (Log Rank p<0.001). The median time to colectomy was 5years from UC diagnosis in high IgG4 group vs. 12years in the normal IgG4 group (p=0.01). CONCLUSIONS: Elevated IgG4 was seen in a small number of PSC patients. Most of these patients had associated UC, were younger at the time of PSC diagnosis, more likely to have backwash ileitis and had reduced colectomy-free survival than patients with normal IgG4.
Udayakumar Navaneethan; Preethi Gk Venkatesh; Maria Choudhary; Bo Shen; Ravi P Kiran
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-1
Journal Detail:
Title:  Journal of Crohn's & colitis     Volume:  -     ISSN:  1876-4479     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101318676     Medline TA:  J Crohns Colitis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.
Department of Gastroenterology, Digestive disease Institute, The Cleveland Clinic, Cleveland, OH, USA.
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