IgG4-related disease involvement of the digestive tract is very rare. In few reported cases of isolated gastric/duodenal IgG4-related disease, none of which resulted in luminal obstruction. A 59 years old female presented with longstanding gastrointestinal symptoms. CT showed mural thickening of the proximal duodenum. Gastroscopy showed antral ulcer extending into the duodenum with outlet obstruction and biopsy showed acute on chronic duodenitis. Whipple’s procedure was performed and IgG4-related disease was diagnosed on final pathology. Symptoms were revolved on mycophenolate mofetil and prednisone with no recurrence. Our case is the only reported case with gastric outlet obstruction secondary to gastroduodenal IgG4-related disease. The diagnosis should be considered in the differential diagnosis of unexplained duodenal stricture, gastric outlet obstruction or gastrointestinal ulceration. IgG4-related disease usually responds to steroids but long-term response rates to steroid-sparing agents, especially in the subset of patients with luminal IgG4-related disease remains to be determined.

中文翻译：

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IgG4相关疾病作为胃出口梗阻的罕见原因：病例报告和文献复习

消化道的 IgG4 相关疾病非常罕见。在少数报道的孤立性胃/十二指肠 IgG4 相关疾病病例中，没有一例导致管腔阻塞。一名 59 岁女性因长期胃肠道症状就诊。CT显示近端十二指肠壁增厚。胃镜检查显示胃窦溃疡延伸至十二指肠并伴有出口梗阻，活检显示慢性十二指肠炎为急性。进行了惠普尔手术，并在最终病理学上诊断出 IgG4 相关疾病。症状围绕吗替麦考酚酯和泼尼松治疗，无复发。我们的病例是唯一报道的继发于胃十二指肠 IgG4 相关疾病的胃出口梗阻病例。在不明原因的十二指肠狭窄的鉴别诊断中应考虑该诊断，胃出口梗阻或胃肠道溃疡。IgG4 相关疾病通常对类固醇有反应，但对类固醇保留药物的长期反应率仍有待确定，尤其是在患有 luminal IgG4 相关疾病的患者中。