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| Diagnosis and treatment of autoimmune pancreatitis: experience with 100 patients |
| Lei Xin, Yuan-Xiang He, Xiao-Fei Zhu, Qun-Hua Zhang, Liang-Hao Hu, Duo-Wu Zou, Zhen-Dong Jin, Xue-Jiao Chang, Jian-Ming Zheng, Chang-Jing Zuo, Cheng-Wei Shao, Gang Jin, Zhuan Liao and Zhao-Shen Li |
Shanghai, China
Author Affiliations: Department of Gastroenterology (Xin L, Zhu XF, Hu LH, Zou DW, Jin ZD, Liao Z and Li ZS), Department of Pathology (Chang XJ and Zheng JM), Department of Nuclear Medicine (Zuo CJ), Department of Radiology (Shao CW), and Department of General Surgery (Jin G), Changhai Hospital, Second Military Medical University, Shanghai 200433, China; Department of Surgical Oncology, Chinese PLA General Hospital, Beijing 100853, China (He YX); Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China (Zhang QH)
Corresponding Author: Prof. Zhao-Shen Li, MD, PhD, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China (Tel: +86-21-31161335; Fax: +86-21-55621735; Email: zhaoshenli@hotmail.com) |
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Abstract BACKGROUND: Autoimmune pancreatitis (AIP) is increasingly recognized as a unique subtype of pancreatitis. This study aimed to analyze the diagnosis and treatment of AIP patients from a tertiary care center in China.
METHODS: One hundred patients with AIP who had been treated from January 2005 to December 2012 in our hospital were enrolled in this study. We retrospectively reviewed the data of clinical manifestations, laboratory tests, imaging examinations, pathological examinations, treatment and outcomes of the patients.
RESULTS: The median age of the patients at onset was 57 years (range 23-82) with a male to female ratio of 8.1:1. The common manifestations of the patients included obstructive jaundice (49 patients, 49.0%), abdominal pain (30, 30.0%), and acute pancreatitis (11, 11.0%). Biliary involvement was one of the most extrapancreatic manifestations (64, 64.0%). Fifty-six (56.0%) and 43 (43.0%) patients were classified into focal-type and diffuse-type respectively according to the imaging examinations. The levels of serum IgG and IgG4 were elevated in 69.4% (43/62) and 92.0% (69/75) patients. Pathological analysis of specimens from 27 patients supported the diagnosis of lymphoplasmacytic sclerosing pancreatitis, and marked (>10 cells/HPF) IgG4 positive cells were found in 20 (74.1%) patients. Steroid treatment and surgery as the main initial treatments were given to 41 (41.0%) and 28 (28.0%) patients, respectively. The remission rate after the initial treatment was 85.0%. Steroid was given as the treatment after relapse in most of the patients and the total remission rate at the end of follow-up was 96.0%.
CONCLUSIONS: Clinical manifestations, laboratory tests, imaging and pathology examinations in combination could increase the diagnostic accuracy of AIP. Steroid treatment with an initial dose of 30 or 40 mg prednisone is effective and safe in most patients with AIP.
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2014, Vol. 13 
