Evaluation and Management of Autoimmune Pancreatitis: Experience at a Large US Center

Raina, Amit; Yadav, Dhiraj; Krasinskas, Alyssa M.; McGrath, Kevin M.; Khalid, Asif; Sanders, Michael; Whitcomb, David C.; Slivka, Adam
September 2009
American Journal of Gastroenterology;Sep2009, Vol. 104 Issue 9, p2295
Academic Journal
OBJECTIVES:Autoimmune pancreatitis (AIP) is increasingly recognized as a form of chronic pancreatitis. Systematic evaluation and management of AIP in the United States is reported only from one center. Our aim was to review the evaluation and management of AIP at a large tertiary center.METHODS:We retrospectively reviewed information on demographics, clinical presentation, laboratory and imaging findings, extrapancreatic involvement, treatment response, and recurrence in 26 patients with AIP treated at the University of Pittsburgh Medical Center from 1998 to 2007.RESULTS:The median age at presentation was 62.5 years (range: 23–86), 65% were men, and 88% were Caucasians. The most common presentation included new-onset mild abdominal pain (65%), jaundice (62%), and weight loss (42%). Pancreatic mass, enlargement, or prominence on imaging was present in 85% of the patients. Serum IgG4 (immunoglobulin-4) was elevated (>140 mg/dl) in 44% (8/18) at presentation. The most common extrapancreatic finding was extrapancreatic/intrahepatic biliary strictures (35%). Peri-pancreatic vascular complications were noted in 23% of the patients. Six patients underwent partial or complete pancreatectomy. Partial or complete response was observed for initial steroid treatment in 19 patients and for methotrexate in 1 patient. Recurrences were common, especially in patients with extrapancreatic manifestations, and usually responded to a combination of steroids and azathioprine. Any one of the commonly used diagnostic criteria (Mayo Clinic's HISORt criteria, the Japanese Pancreas Society criteria, Korean diagnostic criteria) was fulfilled in 85% of cases.CONCLUSIONS:In this second major US series, we confirm several findings previously reported in AIP. Our study highlights the presence of vascular complications in a subset of patients with AIP. The current diagnostic criteria may not identify all AIP patients.


Related Articles

  • Autoimmune Pancreatitis: Differences Between the Focal and Diffuse Forms in 87 Patients. Frulloni, Luca; Scattolini, Chiara; Falconi, Massimo; Zamboni, Giuseppe; Capelli, Paola; Manfredi, Riccardo; Graziani, Rossella; D'Onofrio, Mirko; Katsotourchi, Anna Maria; Amodio, Antonio; Benini, Luigi; Vantini, Italo // American Journal of Gastroenterology;Sep2009, Vol. 104 Issue 9, p2288 

    OBJECTIVES:Autoimmune pancreatitis (AIP) is a particular type of chronic pancreatitis that can be classified into diffuse and focal forms. The aim of this study was to analyze clinical and instrumental features of patients suffering from the diffuse and focal forms of AIP.METHODS:AIP patients...

  • Alternatives to steroids?! Beneficial effects of immunosuppressant drugs in autoimmune pancreatitis. Seleznik, Gitta; Graf, Rolf // Gut;Mar2014, Vol. 63 Issue 3, p376 

    In this article, the author comments on the findings of a study titled "Autoimmune pancreatitis in MRL/Mp mice is a T-cell mediated disease responsive to cyclosporine A and rapamycin treatment" by T. Schwaiger and colleagues, published in the periodical in a 2014 issue. Topics discussed include...

  • Recurrent Attacks of Autoimmune Pancreatitis Result in Pancreatic Stone Formation. Takayama, Mari; Hamano, Hideaki; Ochi, Yasuhide; Saegusa, Hisanobu; Komatsu, Kenichi; Muraki, Takashi; Arakura, Norikazu; Imai, Yasuharu; Hasebe, Osamu; Kawa, Shigeyuki // American Journal of Gastroenterology;May2004, Vol. 99 Issue 5, p932 

    OBJECTIVES: Autoimmune pancreatitis has been characterized by irregular narrowing of the main pancreatic duct and sonolucent swelling of the parenchyma, both of which are due to lymphoplasmacytic inflammation at the active stage of the disease, and by the absence of pancreatic stone formation....

  • Clinical difficulties in the differentiation of autoimmune pancreatitis and pancreatic carcinoma. Kamisawa, Terumi; Egawa, Naoto; Nakajima, Hitoshi; Tsuruta, Kouji; Okamoto, Atsutake; Kamata, Noriko // American Journal of Gastroenterology;Dec2003, Vol. 98 Issue 12, p2694 

    OBJECTIVES: Autoimmune pancreatitis (AIP) is a newly described entity with characteristic clinical, histologic, and morphologic changes, in which autoimmune mechanisms are involved in pathogenesis. However, difficulties can arise in the differentiation of AlP from pancreatic carcinoma. The aims...

  • Autoimmune pancreatitis can develop into chronic pancreatitis. Masahiro Maruyama; Takayuki Watanabe; Keita Kanai; Takaya Oguchi; Jumpei Asano; Tetsuya Ito; Yayoi Ozaki; Takashi Muraki; Hideaki Hamano; Norikazu Arakura; Shigeyuki Kawa // Orphanet Journal of Rare Diseases;2014, Vol. 9 Issue 1, p1 

    Autoimmune pancreatitis (AIP) has been recognized as a distinct type of pancreatitis that is possibly caused by autoimmune mechanisms. AIP is characterized by high serum IgG4 and IgG4-positive plasma cell infiltration in affected pancreatic tissue. Acute phase AIP responds favorably to...

  • Autoimmune Pancreatitis: Pathologic Subtypes and Their Implications for Its Diagnosis. Sugumar, Aravind; Klöppel, Günter; Chari, Suresh T. // American Journal of Gastroenterology;Sep2009, Vol. 104 Issue 9, p2308 

    Autoimmune pancreatitis (AIP) is a rare but treatable form of pancreatic disease that is being increasingly recognized worldwide. The diagnosis of AIP remains a clinical challenge and the difficulty is compounded by the fact that there are no internationally agreed on diagnostic criteria for...

  • Autoimmune pancreatitis in an 11-year-old boy. Refaat, Rania; Harth, Marc; Proschek, Petra; Lindemayr, Sebastian; Vogl, Thomas J. // Pediatric Radiology;Apr2009, Vol. 39 Issue 4, p389 

    We report a case of histopathologically proven autoimmune pancreatitis in an 11-year-old boy. Abdominal US and MRI showed a focal swelling of the pancreatic head, the latter also showing delayed contrast enhancement. There was diffuse irregular pancreatic duct narrowing, compression of the...

  • Autoimmune pancreatitis in Japan: overview and perspective. Shimosegawa, Tooru; Kanno, Atsushi // Journal of Gastroenterology;2009, Vol. 44 Issue 6, p503 

    Since the rediscovery and definition of autoimmune pancreatitis (AIP) by Yoshida et al. in 1995, the disease has been attracting attention because of its unique clinical features and practical issues. This disease shows very impressive imaging findings, serological changes, and characteristic...

  • Japanese consensus guidelines for management of autoimmune pancreatitis: I. Concept and diagnosis of autoimmune pancreatitis. Okazaki, Kazuichi; Kawa, Shigeyuki; Kamisawa, Terumi; Shimosegawa, Toru; Tanaka, Masao // Journal of Gastroenterology;Mar2010, Vol. 45 Issue 3, p249 

    As the number of patients with autoimmune pancreatitis (AIP) is increasing in Japan, practical guidelines for managing AIP need to be established. Three committees [the professional committee for developing clinical questions (CQs) and statements by Japanese specialists, the expert panelist...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics