Clinical features of autoimmune pancreatitis. 2007

Shigeyuki Kawa, and Hideaki Hamano
Center for Health, Safety and Environmental Management, Shinshu University, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.

Autoimmune pancreatitis is a unique form of chronic pancreatitis characterized by a high serum IgG4 concentration, and complications involving various extrapancreatic lesions. It should be emphasized that autoimmune pancreatitis is easily misdiagnosed as pancreatic cancer. This disease predominantly affects elderly men. The major symptom at onset is obstructive jaundice, while severe abdominal pain is rare. Blood tests have shown abnormal results, which could be attributed mainly to the obstructive jaundice. With regard to autoantibodies, the positive rate for the antinuclear antibody is 40%; however, disease-specific autoantibodies are rarely found. About half of the patients with autoimmune pancreatitis have shown exocrine and endocrine dysfunctions. IgG4 is a sensitive and specific marker for diagnosing autoimmune pancreatitis. In differentiating between pancreatic cancer and autoimmune pancreatitis, IgG4 shows a sensitivity of 90%, a specificity of 98%, and an accuracy of 95%. HLA DRB1*0405-DQB1*0401 alleles are significantly associated with autoimmune pancreatitis, and may present a specific peptide which triggers the autoimmune response. Various imaging findings have shown pancreatic swelling, irregular narrowing of the main pancreatic duct, and stenosis of the lower bile duct. Histology shows a significant presence of lymphocytes, plasma cell infiltration, and fibrosis with abundant IgG4-bearing plasma cell infiltration. After corticosteroid treatment, imaging findings and pancreatic functions usually improve significantly. It is probable that autoimmune pancreatitis is an essentially progressive condition resulting in pancreatic stone formation in a similar way to ordinary chronic pancreatitis.

UI MeSH Term Description Entries
D007074 Immunoglobulin G The major immunoglobulin isotype class in normal human serum. There are several isotype subclasses of IgG, for example, IgG1, IgG2A, and IgG2B. Gamma Globulin, 7S,IgG,IgG Antibody,Allerglobuline,IgG(T),IgG1,IgG2,IgG2A,IgG2B,IgG3,IgG4,Immunoglobulin GT,Polyglobin,7S Gamma Globulin,Antibody, IgG,GT, Immunoglobulin
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001323 Autoantibodies Antibodies that react with self-antigens (AUTOANTIGENS) of the organism that produced them. Autoantibody
D001327 Autoimmune Diseases Disorders that are characterized by the production of antibodies that react with host tissues or immune effector cells that are autoreactive to endogenous peptides. Autoimmune Disease,Disease, Autoimmune,Diseases, Autoimmune
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D050500 Pancreatitis, Chronic INFLAMMATION of the PANCREAS that is characterized by recurring or persistent ABDOMINAL PAIN with or without STEATORRHEA or DIABETES MELLITUS. It is characterized by the irregular destruction of the pancreatic parenchyma which may be focal, segmental, or diffuse. Chronic Pancreatitis

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