Eosinophilic cholangitis is a potentially underdiagnosed etiology in indeterminate biliary stricture

AIM: To investigate presence and extent of eosinophilic cholangitis (EC) as well as IgG4-related disease in patients with indeterminate biliary stricture (IBS).
METHODS: All patients with diagnosis of sclerosing cholang
AIM: To investigate presence and extent of eosinophilic cholangitis (EC) as well as IgG4-related disease in patients with indeterminate biliary stricture (IBS).
METHODS: All patients with diagnosis of sclerosing cholangitis (SC) and histopathological samples such as biopsies or surgical specimens at University Hospital Frankfurt from 2005-2015 were included. Histopathological diagnoses as well as further clinical course were reviewed. Tissue samples of patients without definite diagnosis after complete diagnostic work-up were reviewed regarding presence of eosinophilic infiltration and IgG4 positive plasma cells. Eosinophilic infiltration was as well assessed in a control group of liver transplant donors and patients with primary sclerosing cholangitis.
RESULTS: one hundred and thirty-five patients with SC were included. In 10/135 (13.5%) patients, no potential cause of IBS could be identified after complete diagnostic work-up and further clinical course. After histopathological review, a post-hoc diagnosis of EC was established in three patients resulting in a prevalence of 2.2% (3/135) of all patients with SC as well as 30% (3/10) of patients, where no cause of IBS was identified. 2/3 patients with post-hoc diagnosis of EC underwent surgical resection with suspicion for malignancy. Diagnosis of IgG4-related cholangitis was observed in 7/135 patients (5.1%), whereas 3 cases were discovered in post-hoc analysis. 6/7 cases with IgG4-related cholangitis (85.7%) presented with eosinophilic infiltration in addition to IgG4 positive plasma cells. There was no patient with eosinophilic infiltration in the control group of liver transplant donors (n = 27) and patients with primary sclerosing cholangitis (n = 14).
CONCLUSION: EC is an underdiagnosed benign etiology of SC and IBS, which has to be considered in differential diagnosis of IBS.
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Author:Dirk Walter, Sylvia Hartmann, Eva Herrmann, Jan Franz-Josef Peveling-Oberhag, Wolf Otto Bechstein, Stefan Zeuzem, Martin-Leo Hansmann, Mireen Friedrich-Rust, Jörg Gerhard Albert
URN:urn:nbn:de:hebis:30:3-430137
URL:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5311093
DOI:http://dx.doi.org/10.3748/WJG.v23.i6.1044
ISSN:2219-2840
ISSN:1007-9327
Pubmed Id:http://www.ncbi.nlm.nih.gov/pubmed?term=28246478
Parent Title (English):World journal of gastroenterology
Publisher:WJG Press
Place of publication:Beijing
Document Type:Article
Language:English
Date of Publication (online):2017/03/09
Date of first Publication:2017/02/14
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2017/03/09
Tag:IgG4-related disease; Indeterminate biliary stricture; bile duct stenosis; endoscopic retrograde cholangiopancreatography; endoscopy; eosinophilic cholangitis; primary sclerosing cholangitis
Volume:23
Issue:6
Pagenumber:8
First Page:1044
Last Page:1050
Note:
Copyright © The author(s) 1995-2016. Published by Baishideng Publishing Group Inc. All rights reserved. Articles published by this open-access journal are distributed under the terms of the Creative Commons Attribution-Noncommercial (CC BY-NC 4.0) License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.
HeBIS PPN:446472883
Institutes:Medizin
Dewey Decimal Classification:610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (English):License LogoCreative Commons - Namensnennung-Nicht kommerziell 4.0

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