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Autoimmune Pancreatitis - Diagnosis, Management and Longterm Follow-up

Lookup NU author(s): Dr Kofi Oppong, Professor David Jones, Richard Charnley, Professor Derek Manas, Bryon Jaques, Steven White, Jeremy French, Gourab Sen, Dr Beate Haugk

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Abstract

Background & Aims: Autoimmune pancreatitis (AIP) is a fibroinflammatory condition affecting the pancreas and could present as a multisystem disorder. Diagnosis and management can pose a diagnostic challenge in certain groups of patients. We report our experience of managing this condition in a tertiary pancreaticobiliary centre in the North East of England.Methods: Patients were identified from a prospectively maintained database of patients diagnosed with AIP between 2005 and 2013. Diagnosis of definite/probable AIP was based on the revised HISORt criteria. When indicated, patients were treated with steroids and relapses were treated with azathioprine. All patients have been followed up to date.Results: Twenty-two patients were diagnosed with AIP during this period. All patients had pancreatic protocol CT performed while some patients had either MR or EUS as part of the work up. Fourteen out of 22 (64%) had an elevated IgG4 level (mean: 10.9 g/L; range 3.4 - 31 g/L). Four (18%) patients underwent surgery. Extrapancreatic involvement was seen in 15 (68%) patients, with biliary involvement being the commonest. Nineteen (86%) were treated with steroids and five (23%) required further immunosuppression for treatment of relapses. The mean follow up period was 36.94 months (range 7 - 94).Conclusion: Autoimmune pancreatitis is being increasingly recognized in the British population. Extrapancreatic involvement, particularly extrahepatic biliary involvement seems to be a frequent feature. Diagnosis should be based on accepted criteria as this significantly reduces the chances of overlooking malignancy. Awareness of this relatively rare condition and a multi-disciplinary team approach will help us to diagnose and treat this condition more effectively thereby reducing unnecessary interventions.


Publication metadata

Author(s): Chatterjee S, Oppong KW, Scott JS, Jones DE, Charnley RM, Manas DM, Jaques BC, White SA, French JJ, Sen GS, Haugk B, Nayar MK

Publication type: Article

Publication status: Published

Journal: Journal of Gastrointestinal and Liver Diseases

Year: 2014

Volume: 23

Issue: 2

Pages: 179-185

Print publication date: 01/06/2014

Acceptance date: 10/03/2014

ISSN (print): 1841-8724

ISSN (electronic): 1842-1121

Publisher: Medical University Press

URL: http://dx.doi.org/10.15403/jgld.2014.1121.232.sc1

DOI: 10.15403/jgld.2014.1121.232.sc1


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