{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T21:46:27Z","timestamp":1757540787092,"version":"3.44.0"},"reference-count":12,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,8,5]]},"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:p>A woman in her 20s presented with 6 weeks of fever, persistent vomiting and 28% loss of body weight. Symptoms were refractory to treatment with antiemetics and broad spectrum antibiotics.<\/jats:p>\n               <jats:p>Further investigation via oesophageogastroduedenoscopy revealed a large gastric ulcer and pyloric stricture, causing gastric outlet obstruction (GOO). Biopsies of the stomach and duodenum showed plasma cell infiltration with a large proportion being IgG4 positive.<\/jats:p>\n               <jats:p>Treatment with methylprednisolone, and later prednisolone, quickly improved inflammatory markers and symptoms. Balloon dilatation of the pyloric stricture also improved vomiting, allowing eventual re-establishment of oral nutrition. The patient made a full recovery with maintenance treatment on mycophenolate mofetil.<\/jats:p>\n               <jats:p>IgG4-related disease (IgG4-RD) is a multisystem disorder with unpredictable presentation. The case highlights diagnostic challenges in IgG4-RD and identifies it as a rare differential in upper gastrointestinal symptoms. To our knowledge this is the first published case of IgG4-RD in the duodenum causing GOO.<\/jats:p>","DOI":"10.1136\/bcr-2024-259997","type":"journal-article","created":{"date-parts":[[2024,8,24]],"date-time":"2024-08-24T04:48:07Z","timestamp":1724474887000},"page":"e259997","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["IgG4-related disease presenting with gastric outlet obstruction"],"prefix":"10.1136","volume":"17","author":[{"given":"Benjamin","family":"Masterman","sequence":"first","affiliation":[{"name":"Gastroenterology, Southmead Hospital, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yve","family":"Zhang","sequence":"additional","affiliation":[{"name":"North Bristol NHS Trust, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John D","family":"Pauling","sequence":"additional","affiliation":[{"name":"Southmead Hospital, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeino","family":"Zeino","sequence":"additional","affiliation":[{"name":"Southmead Hospital, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,8,24]]},"reference":[{"key":"2025082703182892000_17.8.e259997.1","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000000680","article-title":"IgG4-related disease: dataset of 235 consecutive patients","volume":"94","author":"Inoue","year":"2015","journal-title":"Medicine (Balt)"},{"key":"2025082703182892000_17.8.e259997.2","doi-asserted-by":"crossref","first-page":"189","DOI":"10.2147\/TCRM.S99985","article-title":"IgG4-related disease: current challenges and future prospects","volume":"12","author":"Lang","year":"2016","journal-title":"Ther Clin Risk Manag"},{"key":"2025082703182892000_17.8.e259997.3","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.1111\/jgh.15980","article-title":"Clinicopathological characteristics of gastric IgG4\u2010related disease: systematic scoping review","volume":"37","author":"Sawada","year":"2022","journal-title":"J of Gastro and Hepatol"},{"key":"2025082703182892000_17.8.e259997.4","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1159\/000501513","article-title":"Immunoglobulin G4-Related Disease Manifesting as Isolated, Typical, and Nontypical Gastroesophageal Lesion: a Research of Literature Review","volume":"101","author":"Khan","year":"2020","journal-title":"Digestion"},{"key":"2025082703182892000_17.8.e259997.5","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1007\/s12664-023-01437-6","article-title":"IgG4-related disorders of the gastrointestinal tract: experience from a tertiary care centre with systematic review of Indian literature","volume":"43","author":"Jain","year":"2024","journal-title":"Indian J Gastroenterol"},{"key":"2025082703182892000_17.8.e259997.6","doi-asserted-by":"crossref","unstructured":"Umehara H , Okazaki K , Kawa S , et al . The 2020 revised comprehensive diagnostic (RCD) criteria for igg4-RD. 2021 Available: https:\/\/doi.org\/10.1080\/14397595.2020.1859710","DOI":"10.1080\/14397595.2020.1859710"},{"key":"2025082703182892000_17.8.e259997.7","doi-asserted-by":"crossref","unstructured":"Xu W-L , Ling Y-C , Wang Z-K , et al . Diagnostic performance of serum igg4 level for igg4-related disease: a meta-analysis. 2016. 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