Gastroenterology
Volume 139, Issue 1 , Pages 140-148 , July 2010

Differences in Clinical Profile and Relapse Rate of Type 1 Versus Type 2 Autoimmune Pancreatitis

  • Raghuwansh P. Sah

      Affiliations

    • Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota
  • ,
  • Suresh T. Chari

      Affiliations

    • Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota
    • Corresponding Author InformationReprint requests Address requests for reprints to: Suresh T. Chari, MD, Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905. fax: (507) 284-0538
  • ,
  • Rahul Pannala

      Affiliations

    • Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota
  • ,
  • Aravind Sugumar

      Affiliations

    • Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota
  • ,
  • Jonathan E. Clain

      Affiliations

    • Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota
  • ,
  • Michael J. Levy

      Affiliations

    • Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota
  • ,
  • Randall K. Pearson

      Affiliations

    • Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota
  • ,
  • Thomas C. Smyrk

      Affiliations

    • Division of Pathology, Mayo Clinic, Rochester, Minnesota
  • ,
  • Bret T. Petersen

      Affiliations

    • Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota
  • ,
  • Mark D. Topazian

      Affiliations

    • Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota
  • ,
  • Naoki Takahashi

      Affiliations

    • Division of Radiology, Mayo Clinic, Rochester, Minnesota
  • ,
  • Michael B. Farnell

      Affiliations

    • Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota
  • ,
  • Santhi S. Vege

      Affiliations

    • Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota

Received 14 September 2009 ,Accepted 22 March 2010.

References 

  1. Gardner TB, Chari ST. Autoimmune pancreatitis. Gastroenterol Clin North Am. 2008;37:439–460vii
  2. Pannala R, Chari ST. Autoimmune pancreatitis. Curr Opin Gastroenterol. 2008;24:591–596
  3. Chari ST, Murray JA. Autoimmune pancreatitis (Part II: the relapse). Gastroenterology. 2008;134:625–628
  4. Chari ST, Smyrk TC, Levy MJ, et al. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol. 2006;4:1010–1016
  5. Notohara K, Burgart LJ, Yadav D, et al. Idiopathic chronic pancreatitis with periductal lymphoplasmacytic infiltration: clinicopathologic features of 35 cases. Am J Surg Pathol. 2003;27:1119–1127
  6. Zamboni G, Luttges J, Capelli P, et al. Histopathological features of diagnostic and clinical relevance in autoimmune pancreatitis: a study on 53 resection specimens and 9 biopsy specimens. Virchows Arch. 2004;445:552–563
  7. Park DH, Kim MH, Chari ST. Recent advances in autoimmune pancreatitis. Gut. 2009;58:1680–1689
  8. Zhang L, Notohara K, Levy MJ, et al. IgG4-positive plasma cell infiltration in the diagnosis of autoimmune pancreatitis. Mod Pathol. 2007;20:23–28
  9. Kamisawa T, Funata N, Hayashi Y. Lymphoplasmacytic sclerosing pancreatitis is a pancreatic lesion of igG4-related systemic disease. Am J Surg Pathol. 2004;28:1114
  10. Kamisawa T, Nakajima H, Egawa N, et al. IgG4-related sclerosing disease incorporating sclerosing pancreatitis, cholangitis, sialadenitis and retroperitoneal fibrosis with lymphadenopathy. Pancreatology. 2006;6:132–137
  11. Deshpande V, Chicano S, Finkelberg D, et al. Autoimmune pancreatitis: a systemic immune complex mediated disease. Am J Surg Pathol. 2006;30:1537–1545
  12. Ghazale A, Chari ST, Zhang L, et al. Immunoglobulin G4-associated cholangitis: clinical profile and response to steroids. Gastroenterology. 2008;134:760–765
  13. Yamamoto N, Fletcher JG, Fidler JL, et al. Mikulicz's disease and systemic IgG4-related plasmacytic syndrome (SIPS). Nihon Rinsho Meneki Gakkai Kaishi. 2008;31:1–8
  14. Takahashi N, Kawashima A, Fletcher JG, et al. Renal involvement in patients with autoimmune pancreatitis: CT and MR imaging findings. Radiology. 2007;242:791–801
  15. Cornell LD, Chicano SL, Deshpande V, et al. Pseudotumors due to IgG4 immune complex tubulointerstitial nephritis associated with autoimmune pancreatitocentric disease. Am J Surg Pathol. 2007;31:1586–1597
  16. Okazaki K, Chiba T. Autoimmune related pancreatitis. Gut. 2002;51:1–4
  17. Otsuki M, Chung JB, Okazaki K, et al. Asian diagnostic criteria for autoimmune pancreatitis: consensus of the Japan-Korea Symposium on Autoimmune Pancreatitis. J Gastroenterol. 2008;43:403–408
  18. Chari ST, Takahashi N, Levy MJ, et al. A diagnostic strategy to distinguish autoimmune pancreatitis from pancreatic cancer. Clin Gastroenterol Hepatol. 2009;7:1097
  19. Kamisawa T, Yoshiike M, Egawa N, et al. Treating patients with autoimmune pancreatitis: results from a long-term follow-up study. Pancreatology. 2005;5:234–238
  20. Hirano K, Tada M, Isayama H, et al. Long term prognosis of autoimmune pancreatitis with and without corticosteroid treatment. Gut. 2007;56:1719–1724
  21. Ito T, Nishimori I, Inoue N, et al. Treatment of autoimmune pancreatitis: consensus on the treatment for patients with autoimmune pancreatitis in Japan. J Gastroenterol. 2007;42(Suppl XVIII):50–58
  22. Ghazale A, Chari S. Optimising corticosteroid treatment for autoimmune pancreatitis. Gut. 2007;56:1650–1652
  23. Kamisawa T, Shimosegawa T, Okazaki K, et al. Standard steroid therapy for autoimmune pancreatitis. Gut. 2009;58:1504–1507
  24. Kamisawa T, Okamoto A, Wakabayashi T, et al. Appropriate steroid therapy for autoimmune pancreatitis based on long term outcome. Scand J Gastroenterol. 2008;43:609–613
  25. Nishino T, Toki F, Oyama H, et al. Long term outcome of autoimmune pancreatitis after oral prednisolone therapy. Intern Med. 2006;45:497–501
  26. Wakabayashi T, Kawaura Y, Satomura Y, et al. Long term prognosis of duct narrowing chronic pancreatitis (Strategy for steroid treatment). Pancreas. 2005;30:31–39
  27. Church NI, Pereira SP, Deheragoda MG, et al. Autoimmune pancreatitis: clinical and radiological features and objective response to steroid therapy in a UK series. Am J Gastroenterol. 2007;102:2417–2425
  28. Kubota K, Iida H, Fujisawa T, et al. Clinical factors predictive of spontaneous remission or relapse in cases of autoimmune pancreatitis. Gastroenterol Endosc. 2007;66:1142–1151
  29. Ryu KJ, Chung JB, Park SW, et al. Review of 67 patients with autoimmune pancreatitis in Korea—a multicenter nationwide study. Pancreas. 2008;37:377–385
  30. Frulloni L, Scattolini C, Falconi M, et al. Autoimmune pancreatitis: differences between the focal and diffuse forms in 87 patients. Am J Gastroenterol. 2009;104:2288–2294
  31. Kamisawa T, Atsutake O. Prognosis of autoimmune pancreatitis. J Gastroenterol. 2007;42(Suppl XVIII):59–62
  32. Takayama M, Hamano H, Ochi Y, et al. Recurrent attacks of autoimmune pancreatitis result in pancreatic stone formation. Am J Gastroenterol. 2004;99:932–937
  33. Kim KP, Kim MH, Dong MH, et al. Autoimmune chronic pancreatitis. Am J Gastroenterol. 2004;99:1605–1616
  34. Raina A, Yadav D, Krasinskas AM, et al. Evaluation and management of autoimmune pancreatitis: experience at a large US center. Am J Gastroenterol. 2009;104:2295–2306
  35. Sandanayake NS, Church NI, Chapman MH, et al. Presentation and management of post-treatment relapse in autoimmune pancreatitis/immunoglobulin G4-associated cholangitis. Clin Gastroenterol Hepatol. 2009;7:1089
  36. Ghazale A, Chari ST. Is autoimmune pancreatitis a risk factor for pancreatic cancer?. Pancreas. 2007;35(4):376
  37. Uchida K, Yazumi S, Nishio A, et al. Long term outcome of autoimmune pancreatitis. J Gastroenterol. 2009;44:726–732
  38. Inoue H, Miyatani H, Sawada Y, et al. A case of pancreas cancer with autoimmune pancreatitis. Pancreas. 2006;33:208–209
  39. Sugumar A, Kloppel G, Chari ST. Autoimmune pancreatitis: pathologic subtypes and their implications for its diagnosis. Am J Gastroenterol. 2009;104:2308–2310
  40. Frulloni L, Lunardi C, Simone R, et al. Identification of a novel antibody associated with autoimmune pancreatitis. N Engl J Med. 2009;361:2135–2142
  41. Ravi K, Chari ST, Vege SS, et al. Inflammatory bowel disease in the setting of autoimmune pancreatitis. Inflamm Bowel Dis. 2009;15:1326–1330
  42. Ozden I, Dizdarogly F, Poyanli A, et al. Spontaneous regression of a pancreatic head mass and biliary obstruction due to autoimmune pancreatitis. Pancreatology. 2005;5:300–303
  43. Wakabayashi T, Motoo Y, Kojima Y, et al. Chronic pancreatitis with diffuse irregular narrowing of the main pancreatic duct. Dig Dis Sci. 1998;43:2415–2425
  44. Sahani DV, Sainani NI, Deshpande V, et al. Autoimmune pancreatitis: disease evolution, staging, response assessment and CT features that predict response to corticosteroid therapy. Radiology. 2009;250:118–129
  45. Takahashi N, Ghazale AH, Smyrk TC, et al. Possible association between IgG4-associated systemic disease with or without autoimmune pancreatitis and non-Hodgkin lymphoma. Pancreas. 2009;38:523–526

 This article has an accompanying continuing medical education activity on page page e12. Learning Objective: Upon completion of reading this article, successful learners will be able to recognize the existence of 2 distinct subtypes within AIP, namely Type 1 and Type 2 with different risks of relapse, as well as identify their characteristic clinical associations and pathology findings, and recognize factors associated with increased risk of relapse.

 Conflicts of interest The authors disclose no conflicts.

PII: S0016-5085(10)00487-7

doi: 10.1053/j.gastro.2010.03.054

Gastroenterology
Volume 139, Issue 1 , Pages 140-148 , July 2010