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Significant increase in IgG4+ plasma cells in gastric biopsy specimens from patients with pernicious anaemia
  1. Ahmed S Bedeir,
  2. Richard H Lash,
  3. Jonathan G Lash,
  4. Mukunda B Ray
  1. Caris Research Institute, Irving, Texas, USA
  1. Correspondence to Dr Ahmed Bedeir, 4207 East Cotton Center Boulevard, Phoenix, AZ 85040, USA; abedeir{at}


Aim To investigate the presence of IgG4+ plasma cells in gastric mucosal biopsy samples from patients with atrophic gastritis (AG) and a history of pernicious anaemia (PA) (AG+PA+).

Methods Gastric mucosal biopsy specimens from 46 patients with AG+PA+ were investigated. As controls, we evaluated specimens from patients with AG but no history of PA (AG+ PA–) (n=25), normal histology (n=25), mild chronic inactive gastritis (MCIG) (n=25) or Helicobacter pylori gastritis (HP) (n=25). IgG4+ plasma cells were detected by two immunohistochemical methods: (1) using a monoclonal antibody, the average of the three most cellular high-power fields was counted in areas with the highest density of IgG4+ plasma cells; (2) using a dual-chromagen stain for both IgG4 and CD138 (plasma cell marker), the number of IgG4+ cells per 200 CD138+ plasma cells was counted. The latter was used to ensure that the number of IgG4+ cells was not simply related to the degree of inflammation (density of plasma cells).

Results Identical results were obtained with the two staining methods. Increased numbers of IgG4+ plasma cells were present in 37% of patients with AG+PA+, but in none with AG+PA–, MCIG, HP or normal gastric biopsy results (100% specific, p=0.0001).

Conclusion IgG4+ plasma cells may play a role in the pathogenesis of PA and may be a useful marker for its diagnosis.

  • Chronic atrophic gastritis
  • autoimmune gastritis
  • pernicious anaemia, IgG4

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Caris Diagnostics Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.