Autoimmune Pancreatitis Successfully Treated with Ursodeoxycholic Acid.

Abstract

A 51-year-old womanwith autoimmune pancreatitis is reported in whomtreatment with ursodeoxycholic acid (UDCA) was beneficial. Complaining of epigastric discomfort, she presented with liver dysfunction of the cholestatic type, and diabetes mellitus. Pancreatic imaging revealed a diffuse swelling of the body, an irregular narrowing of the main pancreatic duct, and a terminal stricture of the common bile duct. Histologically, the biopsied pancreas was replaced by fibrous tissue with a small amount of mononuclear cell infiltration. She had anti-carbonic anhydrase-II antibody and anti-lactoferrin antibody. After treatment with UDCA, her liver dysfunction and diabetes mellitus improvedand the pancreas size was reduced. Steroid therapy is usually indicated for this disorder, but UDCA maybe given as an alternative choice.

Tauroursodeoxycholic acid reduces endoplasmic reticulum stress, acinar cell damage, and systemic inflammation in acute pancreatitis

“…Therefore, pharmacological agents that promote eIF-2␣ phosphorylation and ATF4 induction without adding to cell stress may be useful tools in a wide range of clinical situations in anticipation of cellular injury. It may further explain successful treatments of idiopathic and autoimmune pancreatitis by bile salts demonstrated in several case reports and small pilot studies in humans (49,57,59). Thus this treatment strategy may become important, even since a recent publication showed a connection between ER stress and chronic hereditary pancreatitis (26).…”

Tauroursodeoxycholic acid reduces endoplasmic reticulum stress, trypsin activation, and acinar cell apoptosis while increasing secretion in rat pancreatic acini

“…In connection with future in vivo studies, the data may open new perspectives on the use of chemical chaperones as a therapeutic approach optimizing exocrine pancreas function and reducing pancreatic cell damage under conditions of overstimulation and inflammation. It may further explain successful treatments of idiopathic and autoimmune pancreatitis by bile salts demonstrated in several case reports and small pilot studies in humans (38,46,49). Thus this treatment strategy may become important, even though a recent publication showed a connection between ER stress and hereditary pancreatitis (19).…”

Treatment for autoimmune pancreatitis: consensus on the treatment for patients with autoimmune pancreatitis in Japan

“…19 In one case of AIP, it was reported that UDCA was effective for diabetes mellitus and pancreatic swelling, as well as the liver dysfunction. 20 UDCA is well known to be effective for primary biliary cirrhosis (PBC) through its bile fl ow increment and immune-modulation activity. UDCA may be an alternative therapy for AIP, especially in cases involving the biliary tract, but further studies to clarify the pathogenesis and establish a standard therapy are necessary.…”