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Esophageal IgG4

Clinical, Endoscopic, and Histologic Correlations in Eosinophilic Esophagitis

Pope, Amanda E.*; Stanzione, Nicholas; Naini, Bita V.; Garcia-Lloret, Maria; Ghassemi, Kevin A.§; Marcus, Elizabeth A.*,¶; Martin, Martin G.*; Wozniak, Laura J.*

Journal of Pediatric Gastroenterology and Nutrition: May 2019 - Volume 68 - Issue 5 - p 689–694
doi: 10.1097/MPG.0000000000002227
Original Article: Gastroenterology: Eosinophilic Gastrointestinal Diseases

Objective: Recent studies show increased serum and esophageal IgG4 in patients with eosinophilic esophagitis (EoE), suggesting a possible IgG4-involved process. The role of IgG4 in pediatric EoE has not been extensively investigated. Our aim was to analyze IgG4 in esophageal tissue in children in parallel to that in adults with EoE.

Methods: In a retrospective institutional review board–approved study, we performed immunohistochemical staining of IgG4 in esophageal biopsy specimens from 39 subjects: children with EoE (n = 16), adults with EoE (n = 15), children with reflux esophagitis (n = 4), and pediatric controls (n = 4). We assessed the relationships between IgG4 staining and clinical, endoscopic, and histopathologic characteristics.

Results: Patients with EoE were significantly more likely to stain positively for IgG4 than children with reflux esophagitis or controls (P = 0.015). Fifteen of 31 (48%) EoE cases stained positively for IgG4. None of the reflux esophagitis or control cases stained positively. IgG4 staining had 48% sensitivity and 100% specificity for EoE. There was a trend toward IgG4 staining being associated with foreign body/food impaction (P = 0.153). There was a strong association between distal IgG4 staining and basal zone hyperplasia (P = 0.003).

Conclusions: Our study suggests IgG4 is not a consistent finding of EoE at disease diagnosis. Although IgG4 staining was specific for EoE, it had a poor sensitivity with positive staining in only 48% of EoE patients. Further studies are warranted to fully elucidate the role of IgG4 in EoE.

*Division of Pediatric Gastroenterology, Hepatology and Nutrition

Pathology and Laboratory Medicine

Allergy and Immunology

§Gastroenterology, UCLA

VA Greater Los Angeles Health System, Los Angeles, CA.

Address correspondence and reprint requests to Laura J. Wozniak, MD, MS, Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California Los Angeles, 10833 Le Conte Ave, MDCC 12-383, Los Angeles, CA 90095 (e-mail:

Received 5 June, 2018

Accepted 27 October, 2018

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The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,