Clinicopathological characteristics of gastric IgG4-related disease: Systematic scoping review

Haruki Sawada, Torrey Czech, Krixie Silangcruz, Landon Kozai, Adham Obeidat, Eric Andrew Wien, Midori Filiz Nishimura, Asami Nishikori, Yasuharu Sato, Yoshito Nishimura

Research output: Contribution to journalReview articlepeer-review


Background and Aim: Gastric IgG4-related disease (IgG4-RD) can mimic malignancy, submucosal tumors (SMT), and ulcers, leading to over-triage and unnecessary medical interventions such as gastrectomy. The variability in the clinicopathological presentation of IgG4-related disease is not yet well defined, posing a diagnostic challenge. Methods: Following the PRISMA Extension for Scoping Reviews, we searched MEDLINE and EMBASE for all peer-reviewed articles using keywords including “gastritis,” “stomach,” “gastrointestinal stromal tumor,” and “IgG4-RD” from their inception to December 28, 2021. Results: Thirty-nine articles, including 2 observational studies and 42 cases, were included in the systematic review. While bottom-heavy lymphoplasmacytic mucosal infiltration is a characteristic finding of gastric IgG4-RD, it was only present in less than half of the patients in the observational studies. Patients with gastric IgG4-RD were more likely to be diagnosed with gastrointestinal stromal tumor (GIST), gastric cancer, or peptic ulcer disease and their clinical course involved resection (51.3%) or even gastrectomy. Diagnosis of gastric IgG4-RD was most frequently made by post-operative pathological analysis. Conclusion: This systematic review summarizes the current understanding of the characteristics of gastric IgG4-RD. Increased awareness of gastric IgG4-RD as a differential diagnosis of gastric SMT or ulcers among clinicians is crucial in order to reduce unnecessary high-risk, invasive interventions.

Original languageEnglish
Pages (from-to)1865-1872
Number of pages8
JournalJournal of Gastroenterology and Hepatology (Australia)
Issue number10
Publication statusPublished - Oct 2022


  • gastritis
  • gastrointestinal stromal tumor
  • IgG4-related disease
  • systematic review

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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