Diagnosis and treatment of autoimmune pancreatitis.

Published on Sep 1, 2018in Current Opinion in Gastroenterology3.225
· DOI :10.1097/MOG.0000000000000454
Nicolò de Pretis8
Estimated H-index: 8
(University of Verona),
Giulia De Marchi6
Estimated H-index: 6
,
Luca Frulloni58
Estimated H-index: 58
Sources
Abstract
Purpose of review Clinical management of autoimmune pancreatitis changed over the last years. The lack of high-quality studies, probably due to the relative rarity of the disease, has not fully clarified many diagnostic and therapeutic aspects. Aim of this review is to overview the literature from a clinical point of view, focusing on diagnostic and therapeutic approach to this complicated disease. Recent findings They have been focused mainly on the risk of misdiagnosing a cancer. Many significant articles have been published on the treatment strategies of autoimmune pancreatitis, considering both induction and maintenance therapy. Summary Diagnosis of autoimmune pancreatitis remains challenging, particularly in focal pancreatic involvement, despite recent advances on imaging modalities. Treatment is based on induction and maintenance phases. Steroid treatment remains the best option to induce remission. Maintenance therapy may be used to prevent disease relapses, and low-dose steroids, azathioprine or rituximab are the therapeutic options. However, it remains unclear which patient needs to be treated.
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BACKGROUND:Sporadic autoimmune pancreatitis (AIP) cases showing remission without steroid treatment have been reported, however, the clinical course of these patients has not been clarified. This study sought to clarify the clinical course in AIP patients with hesitation for steroid treatment. METHODS:We collected clinical data for AIP patients from high-volume centers in Japan. Data for AIP patients with and those without steroid treatment (steroid treatment vs. wait and see policy or W&S) were...
5 CitationsSource
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OBJECTIVES: Serum IgG4 level is a useful diagnostic marker of autoimmune pancreatitis (AIP); however, it is difficult to predict relapse. We investigated whether a change in serum IgG4 is predictive of AIP relapse during maintenance therapy. METHODS: Seventy-three patients with AIP treated with steroids were divided into 3 groups according to their initial serum IgG4 levels: level 1 group (>2-fold upper limit), level 2 group (1- to 2-fold upper limit), and a normal group. The relapse rate and th...
1 CitationsSource
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OBJECTIVE: Differentiation between autoimmune pancreatitis (AIP) and pancreatic cancer (PC) is a clinical challenge. Emerging published data on the accuracy of serum immunoglobulin G4 (IgG4) for the differential diagnosis between AIP and PC are inconsistent. The objective of our study was to perform a meta-analysis evaluating the clinical utility of serum IgG4 in the differential diagnosis between AIP and PC. METHODS: We performed a systematic literature search of multiple electronic databases. ...
4 CitationsSource
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Autoimmune pancreatitis (AIP) shares overlapping clinical features with pancreatic cancer (PC). Importantly, treatment of the two conditions is different. We investigated the clinical usefulness of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with suspected AIP before treatment. From September 2008 to July 2016, 53 patients with suspected AIP at National Taiwan University Hospital had PET/CT prior to therapy to exclude malignancy and evaluate...
18 CitationsSource
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15 CitationsSource
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Background 18F-FDG PET/CT could satisfactorily show pancreatic and extra-pancreatic lesions in AIP, which can be mistaken for pancreatic cancer (PC). This study aimed to identify 18F-FDG PET/CT findings that might differentiate AIP from PC.
20 CitationsSource
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Abstract Background Elevation in the serum immunoglobulin-G4 (IgG4) level has been used as a diagnostic marker to distinguish autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC), but its true utility is ill-defined. This study evaluates the clinical utility of IgG4 in differentiating AIP from PDAC. Methods All patients evaluated in the hepatopancreaticobiliary surgery clinics with measured serum IgG4 were included. Patients were divided into normal IgG4 ( Results Between 1...
7 CitationsSource
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The International Consensus Diagnostic Criteria (ICDC) for the diagnosis of autoimmune pancreatitis (AIP) include the histological criterion that is based on either pancreatic core needle biopsies (CNBs) or surgical specimens. However, CNBs are difficult to obtain by endoscopic ultrasound (EUS). EUS fine-needle aspiration (EUS-FNA) cytology is usually not sufficient for the diagnosis of AIP, but may sometimes contain tissue microfragments. Another approach is EUS-guided histological fine-needle ...
14 CitationsSource
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Objectives The aim of this study was to review the suitability of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) for ruling out malignancy in autoimmune pancreatitis patients. Methods We retrospectively reviewed 40 autoimmune pancreatitis patients (type 1:37 patients; type 2: two patients; possible autoimmune pancreatitis: one patient) who received EUS-FNA. Among the 40 autoimmune pancreatitis patients, 34 were not histopathologically diagnosed with autoimmune pancreatitis by...
9 CitationsSource
#1Luca FrulloniH-Index: 58
#2Nicolò de PretisH-Index: 8
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Autoimmune pancreatitis (AIP) is a fibro-inflammatory disease of the pancreas with a postulated immune-mediated mechanism (1,2). Two different histologic subtypes have been described, type 1 and type 2 AIP (3). Type 1 AIP is a more aggressive disease in terms of recurrences and extra-pancreatic organ involvement. International consensus diagnostic criteria (ICDC) have been established to classify the disease without definitive histology (4). ICDC introduced not otherwise specified (NOS) AIP as a...
5 CitationsSource
Cited By1
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#1Nicolò de PretisH-Index: 8
#2Antonio AmodioH-Index: 13
Last. Luca FrulloniH-Index: 11
view all 3 authors...
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