Digestive and Liver Disease
Volume 42, Issue 2 , Pages 92-98 , February 2010

Autoimmune pancreatitis: A challenging diagnostic puzzle for clinicians

  • E. Buscarini

      Affiliations

    • Gastroenterology Department, Maggiore Hospital, Largo Dossena 2, 26013 Crema, Italy
    • Corresponding Author InformationCorresponding author. Tel.: +39 0373 280320; fax: +39 0373 280654.
    • ,
  • L. Frulloni

      Affiliations

    • Department of Biomedical and Surgical Sciences, University of Verona, Verona, Italy
    • ,
  • S. De Lisi

      Affiliations

    • Cattedra & Unità Operativa di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
    • ,
  • M. Falconi

      Affiliations

    • Department of Anesthesiological and Surgical Sciences, University of Verona, Verona, Italy
    • ,
  • P.A. Testoni

      Affiliations

    • Gastroenterology Department, I.R.C.C.S San Raffaele, University Vita e Salute San Raffaele, Milan, Italy
    • ,
  • A. Zambelli

      Affiliations

    • Gastroenterology Department, Maggiore Hospital, Largo Dossena 2, 26013 Crema, Italy

Received 1 August 2009 ,Accepted 27 August 2009.

References 

  1. Yoshida K, Toki F, Takeuchi T, et al. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci. 1995;40:1561–1568
  2. Cavallini G. Is chronic pancreatitis a primary disease of the pancreatic ducts? A new pathogenetic hypothesis. Ital J Gastroenterol. 1993;25:391–396
  3. Ectors N, Maillet B, Aerts R, et al. Non-alcoholic duct destructive chronic pancreatitis. Gut. 1997;41:263–268
  4. Kamisawa T, Funata N, Hayashi Y. Lymphoplasmacytic sclerosing pancreatitis is a pancreatic lesion of IgG4-related systemic disease. Am J Surg Pathol. 2004;28:1114
  5. Kawamoto S, Siegelman SS, Hruban RH, et al. Lymphoplasmacytic sclerosing pancreatitis (autoimmune pancreatitis): evaluation with multidetector CT. Radiographics. 2008;28:157–170
  6. Wakabayashi T, Kawaura Y, Satomura Y, et al. Duct-narrowing chronic pancreatitis without immunoserologic abnormality: comparison with duct-narrowing chronic pancreatitis with positive serological evidence and its clinical management. Dig Dis Sci. 2005;50:1414–1421
  7. Okazaki K, Kawa S, Kamisawa T, et al. Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal. J Gastroenterol. 2006;41:626–631
  8. Kim MH, Kwon S. Diagnostic criteria for autoimmune chronic pancreatitis. J Gastroenterol. 2007;42(Suppl. 18):42–49
  9. Finkelberg DL, Sahani D, Deshpande V, et al. Autoimmune pancreatitis. N Engl J Med. 2006;355:2670–2676
  10. Manfredi R, Graziani R, Cicero C, et al. Autoimmune pancreatitis: CT patterns and their changes after steroid treatment. Radiology. 2008;247:435–443
  11. Frulloni L, Scattolini C, Falconi M, et al. Autoimmune pancreatitis: differences between the focal and diffuse forms in 87 patients. Am J Gastroenterol. 2009;104:2288–2294
  12. Otsuki M, Chung JB, Okazaki K, et al. Asian diagnostic criteria for autoimmune pancreatitis: consensus of the Japan–Korea symposium on autoimmune pancreatitis. J Gastroenterol. 2008;43:403–408
  13. Bodily KD, Takahashi N, Fletcher JG, et al. Autoimmune pancreatitis: pancreatic and extrapancreatic imaging findings. Am J Roentgenol. 2009;1(92):431–437
  14. Frulloni L, Gabbrielli A, Pezzilli R, et al. Chronic pancreatitis: report from a multicenter Italian survey (PanCroInfAISP) on 893 patients. Dig Liv Dis. 2009;41:311–317
  15. Kim KP, Kim MH, Song MH, et al. Autoimmune chronic pancreatitis. Am J Gastroenterol. 2004;99:1605–1616
  16. Abraham SC, Wilentz RE, Yeo CJ, et al. Pancreaticoduodenectomy (Whipple resections) in patients without malignancy: are they all ‘chronic pancreatitis’?. Am J Surg Pathol. 2003;27:110–120
  17. Ravi K, Chari ST, Vege SS, et al. Inflammatory bowel disease in the setting of autoimmune pancreatitis. Inflamm Bowel Dis. 2009;15(9):1326–1330
  18. Kawa S, Ota M, Yoshizawa K, et al. HLA DRB10405-DQB10401 haplotype is associated with autoimmune pancreatitis in the Japanese population. Gastroenterology. 2002;122:1264–1269
  19. Hamano H, Kawa S, Horiuchi A, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med. 2001;344:732–738
  20. Ghazale A, Chari ST, Smyrk TC, et al. Value of serum IgG4 in the diagnosis of autoimmune pancreatitis and in distinguishing it from pancreatic cancer. Am J Gastroenterol. 2007;102:1646–1653
  21. Kamisawa T, Chen PY, Tu Y, et al. Pancreatic cancer with a high serum IgG4 concentration. World J Gastroenterol. 2006;12:6225–6228
  22. Raina A, Krasinskas AM, Greer JB, et al. Serum immunoglobulin G fraction 4 levels in pancreatic cancer: elevations not associated with autoimmune pancreatitis. Arch Pathol Lab Med. 2008;132:48–53
  23. Morselli-Labate AM, Pezzilli R. Usefulness of serum IgG4 in the diagnosis and follow up of autoimmune pancreatitis: a systematic literature review and meta-analysis. J Gastroenterol Hepatol. 2009;24:15–36
  24. Taniguchi T, Okazaki K, Okamoto M, et al. High prevalence of autoantibodies against carbonic anhydrase II and lactoferrin in type 1 diabetes: concept of autoimmune exocrinopathy and endocrinopathy of the pancreas. Pancreas. 2003;27:26–30
  25. Kamisawa T, Egawa N, Nakajima H. Autoimmune pancreatitis is a systemic autoimmune disease. Am J Gastroenterol. 2003;98:2811–2812
  26. Okazaki K, Autoimmune-related pancreatitis . Curr Treat Options Gastroenterol. 2001;4:369–375
  27. Okazaki K, Uchida K, Ohana M, et al. Autoimmune-related pancreatitis is associated with autoantibodies and a Th1/Th2-type cellular immune response. Gastroenterology. 2000;118:573–581
  28. Nishino T, Toki F, Oyama H, et al. Biliary tract involvement in autoimmune pancreatitis. Pancreas. 2005;30:76–82
  29. Uchiyama-Tanaka Y, Mori Y, Kimura T, et al. Acute tubulointerstitial nephritis associated with autoimmune-related pancreatitis. Am J Kidney Dis. 2004;43:18–25
  30. Hamano H, Kawa S, Ochi Y, et al. Hydronephrosis associated with retroperitoneal fibrosis and sclerosing pancreatitis. Lancet. 2002;359:1403–1404
  31. Hirano K, Kawabe T, Komatsu Y, et al. High-rate pulmonary involvement in autoimmune pancreatitis’. Intern Med J. 2006;36:58–61
  32. Hirano K, Kawabe T, Yamamoto N, et al. Serum IgG4 concentrations in pancreatic and biliary diseases. Clin Chim Acta. 2006;367:181–184
  33. Kamisawa T, Tu Y, Egawa N, et al. Salivary gland involvement in chronic pancreatitis of various etiologies. Am J Gastroenterol. 2003;98:323–326
  34. Zamboni G, Luttges J, Capelli P, et al. Histopathological features of diagnostic and clinical relevance in autoimmune pancreatitis: a study on 53 resection specimens and 9 biopsy specimens. Virchows Arch. 2004;445:552–563
  35. Kamisawa T, Yoshiike M, Egawa N, et al. Treating patients with autoimmune pancreatitis: results from a long-term follow-up study. Pancreatology. 2005;5:234–238
  36. Notohara K, Burgart LJ, Yadav D, et al. Idiopathic chronic pancreatitis with periductal lymphoplasmacytic infiltration: clinicopathologic features of 35 cases. Am J Surg Pathol. 2003;27:1119–1127
  37. Deshpande V, Chicano S, Finkelberg D, et al. Autoimmune pancreatitis: a systemic immune complex mediated disease. Am J Surg Pathol. 2006;30:1537–1545
  38. Kojima M, Sipos B, Klapper W, et al. Autoimmune pancreatitis: frequency, IgG4 expression, and clonality of T and B cells. Am J Surg Pathol. 2007;31:521–528
  39. Kamisawa T. Immunoglobulin G4-positive plasma cells in organs of patients with autoimmune pancreatitis. Clin Gastroenterol Hepatol. 2008;6:715
  40. Levy MJ, Reddy RP, Wiersema MJ, et al. EUS-guided trucut biopsy in establishing autoimmune pancreatitis as the cause of obstructive jaundice. Gastrointest Endosc. 2005;61:467–472
  41. D’Onofrio M, Martone E, Malago R, et al. Contrast-enhanced ultrasonography of the pancreas. JOP. 2007;8:71–76
  42. Morana G, Tapparelli M, Faccioli N, et al. Autoimmune pancreatitis: instrumental diagnosis. JOP. 2005;6:102–107
  43. Ohana M, Okazaki K, Hajiro K, et al. Multiple pancreatic masses associated with autoimmunity. Am J Gastroenterol. 1998;93:99–102
  44. Koyama R, Imamura T, Okuda C, et al. Ultrasonographic imaging of bile duct lesions in autoimmune pancreatitis. Pancreas. 2008;37:259–264
  45. Numata K, Ozawa Y, Kobayashi N, et al. Contrast-enhanced sonography of autoimmune pancreatitis: comparison with pathologic findings. J Ultrasound Med. 2004;23:199–206
  46. Irie H, Honda H, Baba S, et al. Autoimmune pancreatitis: CT and MR characteristics. Am J Roentgenol. 1998;170:1323–1327
  47. Procacci C, Carbognin G, Biasiutti C, et al. Autoimmune pancreatitis: possibilities of CT characterization. Pancreatology. 2001;1:246–253
  48. Takahashi N, Fletcher JG, Fidler JL, et al. Dual-phase CT of autoimmune pancreatitis: a multireader study. Am J Roentgenol. 2008;190:280–286
  49. Sahani DV, Kalva SP, Farrell J, et al. Autoimmune pancreatitis: imaging features. Radiology. 2004;233:345–352
  50. Takayama M, Hamano H, Ochi Y, et al. Recurrent attacks of autoimmune pancreatitis result in pancreatic stone formation. Am J Gastroenterol. 2004;99:932–937
  51. Kamisawa T, Tu Y, Egawa N, et al. Can MRCP replace ERCP for the diagnosis of autoimmune pancreatitis?. Abdom Imaging. 2009;34:381–384
  52. Nakajo M, Jinnouchi S, Noguchi M, et al. FDG PET and PET/CT monitoring of autoimmune pancreatitis associated with extrapancreatic autoimmune disease. Clin Nucl Med. 2007;32:282–285
  53. Nishino T, Oyama H, Hashimoto E, et al. Clinicopathological differentiation between sclerosing cholangitis with autoimmune pancreatitis and primary sclerosing cholangitis. J Gastroenterol. 2007;42:550–559
  54. Voss M, Hammel P, Molas G, et al. Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses. Gut. 2000;46:244–249
  55. Buscarini E, De Angelis C, Arcidiacono PG, et al. Multicentre retrospective study on endoscopic ultrasound complications. Dig Liver Dis. 2006;38:762–767
  56. Farrell JJ, Garber J, Sahani D, et al. EUS findings in patients with autoimmune pancreatitis. Gastrointest Endosc. 2004;60:927–936
  57. Hyodo N, Hyodo T. Ultrasonographic evaluation in patients with autoimmune-related pancreatitis. J Gastroenterol. 2003;38:1155–1161
  58. Deshpande V, Mino-Kenudson M, Brugge WR, et al. Endoscopic ultrasound guided fine needle aspiration biopsy of autoimmune pancreatitis: diagnostic criteria and pitfalls. Am J Surg Pathol. 2005;29:1464–1471
  59. Japan Pancreas Society . Diagnostic criteria for autoimmune pancreatitis. J Jpn Pancreas Soc. 2002;17:585–587
  60. Kim KP, Kim MH, Kim JC, et al. Diagnostic criteria for autoimmune chronic pancreatitis revisited. World J Gastroenterol. 2006;12:2487–2496
  61. Chari ST, Smyrk TC, Levy MJ, et al. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol. 2006;4:1010–1016
  62. Wakabayashi T, Kawaura Y, Satomura Y, et al. Long-term prognosis of duct-narrowing chronic pancreatitis: strategy for steroid treatment. Pancreas. 2005;30:31–39
  63. Kamisawa T, Okamoto A, Wakabayashi T, et al. Appropriate steroid therapy for autoimmune pancreatitis based on long-term outcome. Scand J Gastroenterol. 2008;43:609–613
  64. Kamisawa T, Okamoto A. Prognosis of autoimmune pancreatitis. J Gastroenterol. 2007;42(Suppl. 18):59–62
  65. Ghazale AH, Chari ST, Vege SS. Update on the diagnosis and treatment of autoimmune pancreatitis. Curr Gastroenterol Rep. 2008;10:115–121
  66. Ghazale A, Chari ST, Zhang L, et al. Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy. Gastroenterology. 2008;134:706–715
  67. Church NI, Pereira SP, Deheragoda MG, et al. Autoimmune pancreatitis: clinical and radiological features and objective response to steroid therapy in a UK series. Am J Gastroenterol. 2007;102:2417–2425

PII: S1590-8658(09)00362-4

doi: 10.1016/j.dld.2009.08.006

Digestive and Liver Disease
Volume 42, Issue 2 , Pages 92-98 , February 2010

Article Tools

* Image Usage & Resolution