Determination of steroid response by abdominal ultrasound in cases with autoimmune pancreatitis

Matsubayashi, Hiroyuki; Yoneyama, Masashi; Nanri, Kazuhide; Sugimoto, Shinya; Shinjo, Kunihiro; Kakushima, Naomi; Tanaka, Masaki; Ito, Sayo; Takao, Madoka; Ono, Hiroyuki

doi:10.1016/j.dld.2013.06.006

Cited by 15 publications

(31 citation statements)

References 33 publications

(57 reference statements)

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“…Typically, a linear or band-like structure, depicted as low density by computed tomography (CT) and a hypo-intensity signal by T2-weight magnetic resonance image (MRI), appears at the margin of the enlarged pancreatic parenchyma and is referred to as a "capsule-like rim", reflecting the fibrous tissue [39,42] . Abdominal ultrasonography (US) and EUS show similar findings to those of early chronic pancreatitis, including hyperechoic foci (91%-100%), hyperechoic strands (30%-81%), lobularity (15%-53%), and a hyperechoic wall of the main pancreatic duct (30%) in cases with AIP, and these findings decrease after steroid therapy [33,43] . Ultrasound of typical diffuse-type AIP shows a diffusely enlarged low-echoic pancreas without ductal dilation, or so-called "sausage-like appearance."…”

Section: Type 2 Aipmentioning

confidence: 58%

“…These systemic lesions include sclerosing cholangitis (60%), sialadenitis (14%), retroperitoneal fibrosis (10%), interstitial pneumonitis (8%), and tubulointerstitial nephritis (8%) [4] , and many other organs are recognized as possible targets of IgG4-RD or type 1 AIP 5 (Table 6). Response to corticosteroid therapy is usually excellent (97%-98%) [33,34] ; however, a high rate of relapse is also observed (56% in 1 year within steroid initiation and 92% within 3 years) ( Table 5). …”

Section: Classification Of Aipmentioning

confidence: 99%

“…Either MRCP or ERP is acceptable in the Korean criteria 17,18 and modality is not specified in the Mayo criteria (HISORt) [9] . The ERCP finding seems to be extremely important in atypical cases [10,33] ; for instance, a case that does not show marked shrinkage following steroid therapy [33,48] or a case of PC mimicking [11] or accompanying [12] AIP.…”

Section: Diagnosismentioning

confidence: 99%

“…Steroid response is seen in 97%-98% of both type 1 and type 2 AIP cases [33,34] ; hence, it is considered a useful diagnostic tool. Moon et al [72] performed a 2 wk steroid trial on 22 consecutive patients with a pancreatic mass lesions atypical for AIP and used by CT and MRCP/ERCP to determine the steroid response.…”

Section: Response To Steroidmentioning

confidence: 99%

“…[51,52] . Relapse is also often recognized in cases with elevated levels of serum IgG [33] or IgG4 [34] . Hence, these serum markers are also applicable to the clinical follow up of patients with type 1 AIP.…”

Section: Serologymentioning

confidence: 99%

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Diagnosis Autoimmune Pancreatitis

Hart¹,

Chari²

The Pancreapedia: Exocrine Pancreas Knowledge Base

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Autoimmune pancreatitis (AIP) is a distinct form of chronic pancreatitis that is increasingly being reported. The presentation and clinical image findings of AIP sometimes resemble those of several pancreatic malignancies, but the therapeutic strategy differs appreciably. Therefore, accurate diagnosis is necessary for cases of AIP. To date, AIP is classified into two distinct subtypes from the viewpoints of etiology, serum markers, histology, other organ involvements, and frequency of relapse: type 1 is related to IgG4 (lymphoplasmacytic sclerosing pancreatitis) and type 2 is related to a granulocytic epithelial lesion (idiopathic duct-centric chronic pancreatitis). Both types of AIP are characterized by focal or diffuse pancreatic enlargement accompanied with a narrowing of the main pancreatic duct, and both show dramatic responses to corticosteroid. Unlike type 2, type 1 is characteristically associated with increasing levels of serum IgG4 and positive serum autoantibodies, abundant infiltration of IgG4-positive plasmacytes, frequent extrapancreatic lesions, and relapse. These findings have led several countries to propose diagnostic criteria for AIP, which consist of essentially similar diagnostic items; however, several differences exist for each country, mainly due to differences in the definition of AIP and the modalities used to diagnose this disease. An attempt to unite the diagnostic criteria worldwide was made with the publication in 2011 of the international consensus diagnostic criteria for AIP, established at the 2010 Congress of the International Association of Pancreatology (IAP).

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Section: Type 2 Aipmentioning

confidence: 58%

Section: Classification Of Aipmentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Response To Steroidmentioning

confidence: 99%

Section: Serologymentioning

confidence: 99%

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Diagnosis Autoimmune Pancreatitis

Hart¹,

Chari²

The Pancreapedia: Exocrine Pancreas Knowledge Base

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Comparison of five-phase computed tomography images of type 1 autoimmune pancreatitis and pancreatic cancer: Emphasis on cases with atypical images

Matsubayashi¹,

Satoh²,

Ishikawa³

et al. 2021

Pancreatology

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Transpapillary biliary stenting is a risk factor for pancreatic stones in patients with autoimmune pancreatitis

et al. 2016

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Background and study aim: Pancreatic stones occasionally develop in autoimmune pancreatitis (AIP), often worsen endocrine and exocrine functions, and occasionally cause pain attacks. However, the risks of pancreatic stones in AIP have been poorly studied. The aim of this study was to analyze the risk factors associated with pancreatic stone formation in cases of AIP. Patients and methods: In total, 50 patients with AIP (39 males, 11 females; mean age 64.0 years), followed up for at least a year, were analyzed for their demographic and clinical findings and pancreatic stone occurrence. Results: In total, 50 patients were followed up for an average of 59.7 (12 – 120) months, with steroid treatment in 44 patients (88 %); pancreatic stones occurred in 14 (28 %) patients after the diagnosis of AIP and endoscopic treatment was needed in one patient with pain attack. The pancreatic stones appeared only in patients with long follow-up period (P < 0.001, 83.9 months vs. 49.6 months), biliary stenting (odds ratio [OR]: 8.40, P = 0.010), relapse (OR: 6.20, P = 0.023), jaundice (OR: 5.40, P = 0.019), and swelling of the duodenal major papilla (OR: 4.67, P = 0.040). Biliary stenting was placed for an average of 9.9 months in 27 patients. Multivariate analysis revealed a significant association only with biliary stenting (P = 0.011). The stones appeared relatively earlier in patients with stones in the main pancreatic duct or Santorini duct (22.1 months) than in patients where pancreatic stones developed elsewhere (53.4 months) (P = 0.018). Conclusions: The risk of pancreatic stone development should be taken into account when a biliary stent is placed in patients with AIP.

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Determination of steroid response by abdominal ultrasound in cases with autoimmune pancreatitis

Cited by 15 publications

References 33 publications

Diagnosis Autoimmune Pancreatitis

Diagnosis Autoimmune Pancreatitis

Comparison of five-phase computed tomography images of type 1 autoimmune pancreatitis and pancreatic cancer: Emphasis on cases with atypical images

Transpapillary biliary stenting is a risk factor for pancreatic stones in patients with autoimmune pancreatitis

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