Clinical Characteristics, Recurrence Features, and Treatment Outcomes of 55 Patients with Autoimmune Pancreatitis.
- Author:
Soo Jung PARK
1
;
Myung Hwan KIM
;
Sung Hoon MOON
;
Jeung Hye HAN
;
Do Hyun PARK
;
Sang Soo LEE
;
Dong Wan SEO
;
Sung Koo LEE
Author Information
1. Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. mhkim@amc.seoul.kr
- Publication Type:Original Article ; English Abstract
- Keywords:
Autoimmune;
Chronic pancreatitis;
IgG4;
Recurrence;
Follow-up
- MeSH:
Adolescent;
Adult;
Aged;
Anti-Inflammatory Agents/therapeutic use;
Autoimmune Diseases/*diagnosis/therapy;
Cholangiopancreatography, Endoscopic Retrograde;
Female;
Humans;
Immunoglobulin G/blood;
Magnetic Resonance Imaging;
Male;
Middle Aged;
Pancreatectomy;
Pancreatitis, Chronic/*diagnosis/pathology/therapy;
Predictive Value of Tests;
Prednisolone/therapeutic use;
Recurrence;
Tomography, X-Ray Computed;
Treatment Outcome
- From:The Korean Journal of Gastroenterology
2008;52(4):230-246
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND/AIMS: The purpose of this study was to assess the clinical characteristics, recurrence features, and treatment results of patients with autoimmune pancreatitis (AIP) and to determine the clinical predictive factors associated with recurrence. METHODS: We analyzed the clinical, radiologic, laboratory, and recurrence features. We also evaluated treatment methods and outcomes, and clinical predictive factors associated with recurrence in 55 patients with AIP. RESULTS: AIP may be misdiagnosed as pancreatic cancer due to the following characteristic features: (1) clinical findings similar to those of pancreatic cancer including weight loss (60.0%), obstructive jaundice (54.5%), and recent-onset diabetes (29.1%) as the major symptoms; (2) a preponderance in elderly men (mean, 57.7 years old; male, 81.8%); (3) pancreatic mass in computer tomography (21.8%). Serum IgG/IgG4 was elevated in 67.4% of cases. Other organ involvements were noted in 43.6% of cases. All patients (52/52) received steroid treatment have shown complete resolution or marked improvement in the presenting manifestations for which steroids were instituted. After median observation period of 32.8 (1-106) months, 9 patients (3-year cumulative recurrence rate, 20.0%) recurred. There was no significant clinical predictive factor for the recurrence of AIP. However, elevated serum IgG4 preceded recurrence in all patients whose serum IgG4 levels were checked at recurrence. CONCLUSIONS: It is reasonable to understand AIP as a pancreatic lesion reflecting systemic disease, so called 'IgG4-related fibroinflammatory disease'. Steroid trial may be a practical diagnostic tool and a therapeutic one. Recurrence was not uncommon after the steroid treatment and serum IgG4 could be a monitoring marker for the recurrence in clinical practice.
