Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3429
Peer-review started: September 19, 2014
First decision: October 29, 2014
Revised: November 17, 2014
Accepted: December 22, 2014
Article in press: December 22, 2014
Published online: March 21, 2015
Processing time: 185 Days and 2.5 Hours
A 61-year-old male from Northeast China presented with a 2-mo history of abdominal distension, pruritus and jaundice. Laboratory testing revealed an elevated serum IgG4 level. A computed tomography scan showed a typical feature of autoimmune pancreatitis (AIP) and cholecystocholangitis. Early gastric cancer was incidentally discovered when endoscopic untrasound-guided fine needle aspiration (EUS-FNA) of the pancreas was carried out. The patient underwent radical subtotal gastrectomy for gastric cancer combined with cholecystectomy. Helicobacter pylori (H. pylori) and IgG4-positive plasmacytes were detected in gastric cancer tissue, pancreatic EUS-FNA sample and resected gallbladder specimen by immunohistochemistry. The patient was diagnosed with H. pylori-positive IgG4-related AIP and sclerosing cholecystocholangitis as well as H. pylori-positive gastric cancer. He responded well to steroid therapy and remains healthy with no signs of recurrence at one year follow-up. We speculate that H. pylori might act as a trigger via direct or indirect action in the initiation of onset of gastric cancer and multiorgan IgG4-related disease.
Core tip: We report a rare case of a 61-year-old male patient who suffered from Helicobacter pylori (H. pylori)-positive IgG4-related autoimmune pancreatitis and sclerosing cholecystocholangitis as well as H. pylori-positive gastric cancer. The patient responded well to corticosteroid therapy after he underwent radical subtotal gastrectomy for gastric cancer combined with cholecystectomy. This report supports the role of H. pylori in the initiation of onset of gastric cancer and multiorgan IgG4-related disease.