Standard steroid treatment for autoimmune pancreatitis

Published on Nov 1, 2009in Gut19.819
· DOI :10.1136/GUT.2008.172908
Terumi Kamisawa60
Estimated H-index: 60
(Tokyo Metropolitan Komagome Hospital),
Tooru Shimosegawa69
Estimated H-index: 69
(Tohoku University)
+ 16 AuthorsMasao Omata105
Estimated H-index: 105
(UTokyo: University of Tokyo)
Sources
Abstract
Objective: To establish an appropriate steroid treatment regimen for autoimmune pancreatitis (AIP). Methods: A retrospective survey of AIP treatment was conducted in 17 centres in Japan. The main outcome measures were rate of remission and relapse. Results: Of 563 patients with AIP, 459 (82%) received steroid treatment. The remission rate of steroid-treated AIP was 98%, which was significantly higher than that of patients without steroid treatment (74%, 77/104; p Conclusions: The major indication for steroid treatment in AIP is the presence of symptoms. An initial prednisolone dose of 0.6 mg/kg/day, is recommend, which is then reduced to a maintenance dose over a period of 3–6 months. Maintenance treatment with low-dose steroid reduces but dose not eliminate relapses.
📖 Papers frequently viewed together
2,772 Citations
20121.55Medicine
349 Citations
1,433 Citations
References20
Newest
#1Makoto Otsuki (University of Occupational and Environmental Health Japan)H-Index: 33
#2Jae Bock ChungH-Index: 31
Last. Yasuyuki Kihara (University of Occupational and Environmental Health Japan)H-Index: 18
view all 15 authors...
In 2002, the Japan Pancreas Society (JPS) was the first in the world to propose diagnostic criteria for autoimmune pancreatitis (AIP). Since the concept of AIP has changed with the accumulation of AIP cases, the Research Committee of Intractable Pancreatic Diseases (RCIPD) provided by the Ministry of Health, Labour and Welfare of Japan and the JPS issued revised clinical diagnostic criteria of AIP in 2006. The Asan Medical Center of Korea also proposed diagnostic criteria for AIP in 2006. Howeve...
564 CitationsSource
#1Suresh T. Chari (Mayo Clinic)H-Index: 83
#2Joseph A. Murray (Mayo Clinic)H-Index: 77
75 CitationsSource
#1Do Hyun Park (SCH: Soonchunhyang University)H-Index: 47
#2Myung-Hwan Kim (UOU: University of Ulsan)H-Index: 68
Last. Sung Koo Lee (UOU: University of Ulsan)H-Index: 53
view all 9 authors...
Background & Aims: Although autoimmune pancreatitis (AIP) responds well to corticosteroid therapy, relapse during maintenance corticosteroid therapy or after the withdrawal of corticosteroid treatment is not uncommon. To date, the factors related to relapse of AIP have not been fully explored. Methods: To determine the clinical and genetic predictors relating to the relapse of AIP, we evaluated clinical factors, HLA polymorphisms, and the amino acid sequences in 40 patients with AIP. Results: At...
167 CitationsSource
#1Terumi KamisawaH-Index: 60
#2Atsutake OkamotoH-Index: 28
Last. Norio Sawabu (Kanazawa University)H-Index: 29
view all 5 authors...
Objective. Because autoimmune pancreatitis (AIP) responds well to corticosteroids, many AIP patients are given this treatment. However, there is no consensus on the indications, dose, or duration of steroid treatment. The aim of this study was to establish the most appropriate steroid therapy regimen. Material and methods. We retrospectively reviewed morphological and serological improvement after steroid therapy and long-term outcome including relapse in 41 AIP patients who were given steroid t...
103 CitationsSource
#1Kensuke Kubota (YCU: Yokohama City University)H-Index: 30
#2Hiroshi Iida (YCU: Yokohama City University)H-Index: 22
Last. A. Nakajima (YCU: Yokohama City University)H-Index: 10
view all 11 authors...
Background The rates of spontaneous remission and relapse of autoimmune pancreatitis (AIP) are not known. Objective To study the clinicopathologic factors predictive of remission and relapse in cases of AIP. Design Retrospective study. Patients Of the 20 patients with AIP, complete response to steroid therapy was recognized in 12 patients, and the remaining 8 patients improved without steroid therapy. Seven patients experienced a relapse. Results Patients who were seronegative for immunoglobulin...
150 CitationsSource
#1Amaar Ghazale (Mayo Clinic)H-Index: 8
#2Suresh T. ChariH-Index: 83
Unanswered questions Autoimmune pancreatitis (AIP) is part of a systemic fibro-inflammatory disease that can involve multiple organs which characteristically have a lymphoplasmacytic infiltrate rich in IgG4-positive cells. IgG4-related systemic disease (ISD) has been proposed by Kamisawa et al as the umbrella term to describe this multi-organ disease.1 Although the fibrosis in ISD can often lead to damage and even destruction of the involved organ, the inflammatory process typically responds to ...
116 CitationsSource
#1Kenji Hirano (UTokyo: University of Tokyo)H-Index: 39
#2Minoru TadaH-Index: 46
Last. Masao OmataH-Index: 105
view all 12 authors...
Objectives: Autoimmune pancreatitis (AIP) is a unique form of chronic pancreatitis, and it has a favorable response to corticosteroid treatment (CST). However, little is known about the long-term outcome of AIP. We aimed to document the prognosis without and with CST, and to examine the indication for CST. Patients and Methods: Prognosis and clinical features of 23 patients without CST and 19 patients treated with CST from onset were investigated. In addition, we examined factors concerning the ...
309 CitationsSource
#1Tetsuhide Ito (Kyushu University)H-Index: 42
#2Isao NishimoriH-Index: 42
Last. Makoto Otsuki (University of Occupational and Environmental Health Japan)H-Index: 33
view all 9 authors...
Autoimmune pancreatitis (AIP) has been characterized by unique clinical imaging, immunological findings, and the effectiveness of steroid therapy. A set of clinicopathological criteria for AIP was proposed by the Japan Pancreatic Society in 2002, and AIP has come to be widely recognized among general digestive clinicians. However, the indication of steroid therapy for AIP is still not well established, and furthermore the therapeutic doses and method of administration of steroid therapy is also ...
161 CitationsSource
#1Tetsuhide Ito (Kyushu University)H-Index: 42
#2Ken KawabeH-Index: 21
Last. Ryoichi Takayanagi (Kyushu University)H-Index: 58
view all 9 authors...
Objectives:Up to now, the characteristics of pancreatic endocrine and exocrine functions in autoimmune pancreatitis (AIP) are still unclear. The aim of this study is to evaluate pancreatic functions in AIP compared with those of chronic pancreatitis (CP).Methods:Twelve patients with AIP and 25 patie
83 CitationsSource
#1Suresh T. Chari (Mayo Clinic)H-Index: 83
#2Thomas C. Smyrk (Mayo Clinic)H-Index: 98
Last. Michael B. Farnell (Mayo Clinic)H-Index: 71
view all 11 authors...
Background & Aims: The Japan Pancreas Society criteria for diagnosis of autoimmune pancreatitis (AIP) mandate presence of characteristic imaging (diffuse pancreatic enlargement with diffusely irregular, narrow pancreatic duct). AIP has unique histologic features associated with infiltration of tissues of affected organs with abundant IgG4-positive cells. We propose expanded diagnostic criteria for AIP with a cohort of histologically confirmed AIP. Methods: We reviewed the pancreatic imaging find...
1,118 CitationsSource
Cited By698
Newest
#1Sushil Kumar GargH-Index: 21
#2Suresh T. ChariH-Index: 83
Source
#1Akane HaraH-Index: 2
#2Tomohiro WatanabeH-Index: 35
Last. Masatoshi KudoH-Index: 88
view all 6 authors...
Source
#1Ummusen Kaya Akca (Hacettepe University)H-Index: 3
#2Erdal Atalay (Hacettepe University)H-Index: 2
Last. Yelda Bilginer (Hacettepe University)H-Index: 25
view all 10 authors...
Objective Immunoglobulin G4-related disease (IgG4-RD) is a systemic, immune-mediated, and fibroinflammatory disease that can affect almost any organ system. We aimed to present our single-center experience of pediatric patients with IgG4-RD, a rare disease in children. Methods Pediatric patients diagnosed with IgG4-RD at the Hacettepe University between June 2014 and September 2020 were evaluated retrospectively. Patients with definite, probable, or possible diagnosis of IgG4-RD were included. R...
Source
#1Yoshihito IijimaH-Index: 6
#2Shun IwaiH-Index: 3
Last. Hidetaka UramotoH-Index: 35
view all 10 authors...
BACKGROUND Immunoglobulin G4 (IgG4)-related diseases are characterized by abnormal IgG4 levels, swelling, and marked infiltration and fibrosis of the lymphocytes and IgG4-positive plasma cells, causing hypertrophic lesions or nodules. The cause is currently not well understood. IgG4-related diseases involving lesions limited to the pleura are extremely rare. Herein, we report an IgG4-related disease presenting with multiple pleural nodules confirmed by thoracoscopic surgical biopsy. CASE PRESENT...
Source
#1Yueying Pan (HUST: Huazhong University of Science and Technology)H-Index: 4
#2Shuchang Zhou (HUST: Huazhong University of Science and Technology)H-Index: 5
Last. Hanxiong Guan (HUST: Huazhong University of Science and Technology)H-Index: 4
view all 6 authors...
The features and treatment of 98 Chinese patients with immunoglobulin G4 (IgG4)-related disease (IgG4-RD) referred to a single tertiary referring centre were reviewed. Patients diagnosed with IgG4-RD according to the comprehensive diagnostic criteria (CDC) were included in the retrospective study from May 2012 to March 2019. We collected data on clinical, laboratory, imaging, histological features and treatment. Totally, 98 patients with IgG4-RD were enrolled. The common clinical manifestations ...
Source
#1Marco Lanzillotta (UniSR: Vita-Salute San Raffaele University)H-Index: 14
#2Andreu Fernández-Codina (UWO: University of Western Ontario)H-Index: 9
Last. Emanuel Della-Torre (UniSR: Vita-Salute San Raffaele University)H-Index: 25
view all 7 authors...
INTRODUCTION Awareness of IgG4-related disease (IgG4-RD) is increasing worldwide and specialists are now familiar with most of its clinical manifestations and mimickers. IgG4-RD promptly responds to glucocorticoids and repeated courses are typically used to induce and maintain remission because the disease relapses in most patients. If left untreated it can lead to organ dysfunction, organ failure and death. Advancement in our understanding of IgG4-RD pathogenesis is leading to the identificatio...
Source
Last. Chao LiuH-Index: 6
view all 8 authors...
Source
#1S. Fukui (International University, Cambodia)
Last. Masato OkadaH-Index: 10
view all 10 authors...
OBJECTIVE Patients with IgG4-Related Disease (IgG4RD) usually require steroid-sparing agents due to relapse with tapering glucocorticoids (GC). The aim of this study was to determine the efficacy and safety of Mizoribine (MZR) among IgG4RD, which inhibits inosine monophosphate dehydrogenase, a rate-limiting enzyme in the de novo pathway of purine synthesis. METHODS We retrospectively reviewed records of IgG4RD patients at the Immuno-Rheumatology Center in St. Luke's International Hospital, Tokyo...
Source
#1Leonardo SpatolaH-Index: 6
#2Federica RaveraH-Index: 3
Last. E MinettiH-Index: 2
view all 9 authors...
IgG4-related disease (IgG4-RD) is still an underestimated disorder which affects multiple organs, and its recognition as a distinct clinical disease has been only proved in the recent decades. The renal involvement has been documented in approximately 15% of patients with IgG4-RD, and the typical manifestation is a tubulo-interstitial nephritis. The main histological findings in IgG4-RD are typically a dense tissue infiltration of IgG4-positive plasma cells, storiform fibrosis, obliterative phle...
Source
#1Junya SatoH-Index: 3
Last. Hiroyuki OnoH-Index: 18
view all 15 authors...
1 CitationsSource