Autoimmune pancreatitis can develop into chronic pancreatitis

Abstract

Autoimmune pancreatitis (AIP) has been recognized as a distinct type of pancreatitis that is possibly caused by autoimmune mechanisms. AIP is characterized by high serum IgG4 and IgG4-positive plasma cell infiltration in affected pancreatic tissue. Acute phase AIP responds favorably to corticosteroid therapy and results in the amelioration of clinical findings. However, the long-term prognosis and outcome of AIP remain unclear. We have proposed a working hypothesis that AIP can develop into ordinary chronic pancreatitis resembling alcoholic pancreatitis over a long-term course based on several clinical findings, most notably frequent pancreatic stone formation. In this review article, we describe a series of study results to confirm our hypothesis and clarify that: 1) pancreatic calcification in AIP is closely associated with disease recurrence; 2) advanced stage AIP might have earlier been included in ordinary chronic pancreatitis; 3) approximately 40% of AIP patients experience pancreatic stone formation over a long-term course, for which a primary risk factor is narrowing of both Wirsung’s and Santorini’s ducts; and 4) nearly 20% of AIP patients progress to confirmed chronic pancreatitis according to the revised Japanese Clinical Diagnostic Criteria, with independent risk factors being pancreatic head swelling and non-narrowing of the pancreatic body duct.

Pancreatic cancer and autoimmune diseases: An association sustained by computational and epidemiological case–control approaches

“…Conversely, while autoimmune pancreatitis is an AID suggested to develop into chronic pancreatitis, its link with PC risk has not been established . Moreover, it is reasonable to expect a different type of association in AIDs that result in localized damage to the pancreas.…”

“…44 Conversely, while autoimmune pancreatitis is an AID suggested to develop into chronic pancreatitis, its link with PC risk has not been established. 45,46 Moreover, it is reasonable to expect a different type of association in AIDs that result in localized damage to the pancreas. Moreover, one could hypothesize that the decreased risk of certain cancers and AIDs could be the consequence of confounding by particular treatments.…”

Factors related to renal cortical atrophy development after glucocorticoid therapy in IgG4-related kidney disease: a retrospective multicenter study

“…Until now, the response to glucocorticoids has been evaluated by means of identifying radiological abnormalities such as tumefactive or hyperplastic lesions, the clinical symptoms caused by them, and functional parameters of the affected organs, including renal function [8, 10], salivary secretory function [18], and pancreatic exocrine and endocrine function [19, 20]. Numerous reports reveal that these indicators improve at least initially after the initiation of glucocorticoid therapy.…”

“…Transformation into chronic pancreatitis associated with pancreatic stones, atrophy, and exocrine and endocrine dysfunction has been reported in the long-term clinical course of type 1 AIP [19, 20]. A study investigating the long-term clinical course in IgG4-RKD showed that patients with pre-treatment eGFR under 60 mL/min/1.73 m 2 calculated on the basis of the Japanese revised equation for estimating GFR from serum creatinine [22] attained not complete but only partial recovery of renal function one month after the start of glucocorticoid therapy, with residual dysfunction persisting thereafter, and that radiologically, focal or diffuse renal atrophy persisted [8].…”

Changing Trends in the Epidemiology of Pancreatitis in Rural Population: Study at a Tertiary Health Care Centre

“…Numerous factors have been implicated for causation and association of pancreatitis ranging from exogenous elements including lifestyle and behaviour like alcohol [13][14][15] , smoking, tobacco consumption [15,16] , nutrition, diet [17,18] , environmental toxins, geography [19] to endogenous elements like gallstones [1,12,20] , genetics [21] , autoimmunity [22] ,etc.…”