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Gastrointestinal Disorders Associated with Primary Immunodeficiency Diseases

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Abstract

There are now 354 inborn errors of immunity (primary immunodeficiency diseases (PIDDs)) with 344 distinct molecular etiologies reported according to the International Union of Immunological Sciences (IUIS) (Clin Gastroenterol Hepatol 11: p. 1050-63, 2013, Semin Gastrointest Dis 8: p. 22-32, 1997, J Clin Immunol 38: p. 96-128, 2018). Using the IUIS document as a reference and cross-checking PubMed (www.ncbi.nlm.nih.pubmed.gov), we found that approximately one third of the 354 diseases of impaired immunity have a gastrointestinal component [J Clin Immunol 38: p. 96-128, 2018]. Often, the gastrointestinal symptomatology and pathology is the heralding sign of a PIDD; therefore, it is important to recognize patterns of disease which may manifest along the gastrointestinal tract as a more global derangement of immune function. As such, holistic consideration of immunity is warranted in patients with clinically significant gastrointestinal disease. Here, we discuss the manifold presentations and GI-specific complications of PIDDs which could lead patients to seek advice from a variety of clinician specialists. Often, patients with these medical problems will engage general pediatricians, surgeons, gastroenterologists, rheumatologists, and clinical immunologists among others. Following delineation of the presenting concern, accurate and often molecular diagnosis is imperative and a multi-disciplinary approach warranted for optimal management. In this review, we will summarize the current state of understanding of PIDD gastrointestinal disease involvement. We will do so by focusing upon gastrointestinal disease categories (i.e., inflammatory, diarrhea, nodular lymphoid hyperplasia, liver/biliary tract, structural disease, and oncologic disease) with an intent to aid the healthcare provider who may encounter a patient with an as-yet undiagnosed PIDD who presents initially with a gastrointestinal symptom, sign, or problem.

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Authors and Affiliations

  1. Baylor College of Medicine, Section of Immunology Allergy, Rheumatology and Retrovirology, Department of Pediatrics, Texas Children’s Hospital, Houston, TX, USA

    Stella Hartono & Nicholas L. Rider

  2. Luis Razetti School of Medicine, Central University of Venezuela, Caracas, Venezuela

    Michelina Rosa Ippoliti

  3. School of Medicine, University of Zulia, Maracaibo, Venezuela

    Maria Mastroianni

  4. Faculty of Medicine, School of Medicine, University of El Salvador, San Salvador, El Salvador

    Ricardo Torres

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  1. Stella Hartono
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  2. Michelina Rosa Ippoliti
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  3. Maria Mastroianni
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  4. Ricardo Torres
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  5. Nicholas L. Rider
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Correspondence to Nicholas L. Rider.

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Hartono, S., Ippoliti, M.R., Mastroianni, M. et al. Gastrointestinal Disorders Associated with Primary Immunodeficiency Diseases. Clinic Rev Allerg Immunol 57, 145–165 (2019). https://doi.org/10.1007/s12016-018-8689-9

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