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Long-term Prognosis of Autoimmune Pancreatitis without and with Corticosteroid Treatment
  1. Kenji Hirano (khirano-tky{at}umin.ac.jp)
  1. University of Tokyo, Japan
    1. Minoru Tada
    1. University of Tokyo, Japan
      1. Hiroyuki Isayama
      1. University of Tokyo, Japan
        1. Hiroshi Yagioka
        1. University of Tokyo, Japan
          1. Takashi Sasaki
          1. University of Tokyo, Japan
            1. Hirofumi Kogure
            1. University of Tokyo, Japan
              1. Yousuke Nakai
              1. University of Tokyo, Japan
                1. Naoki Sasahira
                1. University of Tokyo, Japan
                  1. Takeshi Tsujino
                  1. University of Tokyo, Japan
                    1. Haruhiko Yoshida
                    1. University of Tokyo, Japan
                      1. Takao Kawabe
                      1. University of Tokyo, Japan
                        1. Masao Omata
                        1. University of Tokyo, Japan

                          Abstract

                          Objectives: Autoimmune pancreatitis (AIP) is a unique form of chronic pancreatitis, and it has a favorable response to corticosteroid treatment (CST). However, little is known about the long-term outcome of AIP. We aimed to document the prognosis without and with CST, and to examine the indication for CST.

                          Patients and Methods: Prognosis and clinical features of 23 patients without CST and 19 patients treated with CST from onset were investigated. In addition, we examined factors concerning the late occurrence of unfavorable events related to AIP.

                          Results: The patients without CST were 19 men and 4 women, with an average age of 66 years. After an average observation period of 25 months, 16 patients (70%) developed unfavorable events including obstructive jaundice due to distal bile duct stenosis in 4, growing pseudocyst in 1, sclerogenic changes of extrapancreatic bile duct in 9, hydronephrosis due to retroperitoneal fibrosis in 1, and interstitial nephritis in 1. Patients with obstructive jaundice at onset showed a higher cumulative event occurrence rate (P=0.025). The patients treated with CST were 16 men and 3 women, with an average age of 64 years. After an average observation period of 23 months, 6 patients (32%) developed unfavorable events consisting of interstitial pneumonia in 3, and recurrence of obstructive jaundice in 3. In multivariate analysis, CST (hazard ratio 0.33, 95% CI 0.12-0.89, P=0.029) and obstructive jaundice at onset (3.09, 1.14-8.32, 0.026) were significant predictive factors for unfavorable events.

                          Conclusion: CST could reduce AIP-related unfavorable events. Early introduction of CST is recommended especially for patients with obstructive jaundice.

                          • autoimmune pancreatitis
                          • corticosteroid
                          • obstructive jaundice
                          • prognosis
                          • sclerosing cholangitis

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