Long-term outcomes of autoimmune pancreatitis: A multicentre, international analysis
Journal
Gut
Journal Volume
62
Journal Issue
12
Pages
1771-1776
Date Issued
2013
Author(s)
Hart P.A.
Kamisawa T.
Brugge W.R.
Chung J.B.
Culver E.L.
Czakó L.
Frulloni L.
Go V.L.W.
Gress T.M.
Kim M.-H.
Kawa S.
Lee K.T.
Lerch M.M.
Löhr M.
Okazaki K.
Ryu J.K.
Schleinitz N.
Shimizu K.
Shimosegawa T.
Soetikno R.
Webster G.
Yadav D.
Zen Y.
Chari S.T.
Abstract
Objective: Autoimmune pancreatitis (AIP) is a treatable form of chronic pancreatitis that has been increasingly recognised over the last decade. We set out to better understand the current burden of AIP at several academic institutions diagnosed using the International Consensus Diagnostic Criteria, and to describe long-term outcomes, including organs involved, treatments, relapse frequency and long-term sequelae. Design 23 institutions from 10 different countries participated in this multinational analysis. A total of 1064 patients meeting the International Consensus Diagnostic Criteria for type 1 (n=978) or type 2 (n=86) AIP were included. Data regarding treatments, relapses and sequelae were obtained. Results: The majority of patients with type 1 (99%) and type 2 (92%) AIP who were treated with steroids went into clinical remission. Most patients with jaundice required biliary stent placement (71% of type 1 and 77% of type 2 AIP). Relapses were more common in patients with type 1 (31%) versus type 2 AIP (9%, p<0.001), especially those with IgG4-related sclerosing cholangitis (56% vs 26%, p<0.001). Relapses typically occurred in the pancreas or biliary tree. Retreatment with steroids remained effective at inducing remission with or without alternative treatment, such as azathioprine. Pancreatic duct stones and cancer were uncommon sequelae in type 1 AIP and did not occur in type 2 AIP during the study period. Conclusions: AIP is a global disease which uniformly displays a high response to steroid treatment and tendency to relapse in the pancreas and biliary tree. Potential long-term sequelae include pancreatic duct stones and malignancy, however they were uncommon during the study period and require additional follow-up. Additional studies investigating prevention and treatment of disease relapses are needed.
SDGs
Other Subjects
azathioprine; cyclophosphamide; immunoglobulin G4; mycophenolic acid 2 morpholinoethyl ester; rituximab; steroid; adult; article; autoimmune pancreatitis; biliary stent; clinical feature; conservative treatment; endoscopic retrograde cholangiopancreatography; female; human; immunoglobulin blood level; international cooperation; jaundice; major clinical study; male; multicenter study (topic); pancreas cancer; pancreas duct stenosis; pancreas resection; priority journal; remission; sclerosing cholangitis; Autoimmune Disease; Pancreatic Cancer; Pancreato-Biliary Disorders; Anti-Inflammatory Agents; Autoimmune Diseases; Female; Humans; Male; Middle Aged; Pancreatitis, Chronic; Prednisolone; Recurrence; Remission Induction; Treatment Outcome
Type
journal article