Abstract
Background
Relapse and spontaneous remission (SR) are characteristic features of autoimmune pancreatitis (AIP).
Aim and methods
We conducted a study to determine if the predictive factors might be potentially related to the relapse in 70 consecutive AIP patients. Regarding SR, we studied the data of patients without corticosteroid treatment (CST).
Results
CST was administered to 60% (42/70) of the patients; however, relapse was noted in 45.2% (19/42) of these patients. In 95% (18/19) of the AIP patients developing relapse, the relapse occurred within 3 years. The relapse rate was 80% (12/15) in the AIP patients administered CST for less than 12 months and 25.9% (7/27) in those administered CST for over 12 months (p < 0.01). The results of univariate analysis revealed significant association of relapse with the presence of jaundice, IgG4 seropositivity, presence of diffuse pancreas swelling, duodenal papillitis (DP), history of initial CST, and history of supportive treatment (p < 0.05), whereas multivariate analysis revealed that IgG4 seropositivity (OR 10.506, p = 0.0422) and the presence of jaundice (OR 6.945, p = 0.0174) are significant independent factors predictive of relapse in AIP patients. SR was recognized in 65.0% (13/20) of AIP patients without CST. The results of univariate analysis revealed that SR was associated with IgG4 seropositivity (p < 0.05), and multivariate analysis identified IgG4 seropositivity (OR 0.032, p = 0.0092) as a significant independent factor predictive of SR in these cases.
Conclusion
AIP patients with IgG4 seropositivity and jaundice are at a higher risk of relapse and they could therefore be candidates for over 3 years of maintenance CST. AIP patients with IgG4 seronegativity have a high likelihood of SR.
Similar content being viewed by others
References
Sarles H, Sarles JC, Muratore R, Guien C. Chronic inflammatory sclerosis of the pancreas: an autonomous pancreatic disease? Am J Dig Dis. 1961;6:688–98.
Yoshida K, Toki F, Takeuti T, Watanabe S, Shiratori K, Hayashi N. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci. 1995;40:1561–8.
Hamano H, Kawa S, Horiuchi A, Unnno H, Furuta N, Akamatsu T, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med. 2001;344:732–8.
Erkelens GW, Vleggaar FP, Lesterhuis W, van Buuren HR, van der Werf SD. Sclerosing pancreato-cholangitis responsive to steroid therapy. Lancet. 1999;354:43–4.
Kubota K, Iida H, Fujisawa T, Yoneda M, Inamori M, Kirikoshi H, et al. Clinical factors predictive of spontaneous remission or relapse in cases of autoimmune pancreatitis. Gastrointest Endosc. 2007;66:1142–51.
Wakabayashi T, Kawaura Y, Satomura Y, Watanabe H, Motoo Y, Sawabu N. Long-term prognosis of duct-narrowing chronic pancreatitis. Strategy for steroid treatment. Pancreas. 2005;30:31–9.
Takayama M, Hamano H, Ochi Y, et al. Recurrent attacks of autoimmune pancreatitis result in pancreatic stone formation. Am J Gastroenterol. 2004;99:932–7.
Hirano K, Tada M, Isayama H, Yagioka H, Sasaki T, Kogure H, et al. Long term prognosis of autoimmune pancreatitis with and without corticosteroid treatment. Gut. 2006;56:1719–24.
Sah RP, Chari ST, Pannala R, Sugumar A, Clain JE, Levy MJ, et al. Differences in clinical profile and relapse rate of type 1 versus type 2 autoimmune pancreatitis. Gastroenterology. 2010;139:140–8.
Ghazale A, Chari ST, Zhang L, Smyrk TC, Takahashi N, Levt MJ, et al. Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy. Gastroenterology. 2008;134:706–15.
Kubota K, Iida H, Fujisawa T, Ogawa M, Inamori M, Saito S, Kakuta Y, Oshiro H, Nakajima A. Clinical significance of swollen duodenal papilla in autoimmune pancreatitis. Pancreas. 2007;35:e51–60.
Otsuki M, Chung JB, Okazaki K, Kim MH, Kamisawa T, Kawa S, et al. Asian diagnostic criteria for autoimmune pancreatitis: consensus of the Japan–Korea symposium on autoimmune pancreatitis. J Gastroenterol. 2008;43:403–8.
Bodily KD, Takahashi N, Fletcher JG, Finder J, Hough DM, Kawashima A, Chari ST. Autoimmune pancreatitis: pancreatic and extrapancreatic imaging findings. AJR. 2009;192:431–7.
Kamisawa T, Shimosegawa T, Okazaki K, Nishino T, Watanabe H, Kanno A, et al. Standard steroid therapy for autoimmune pancreatitis. GUT. 2009;58:1504–7.
Ghazale A, Chari S. Optimising corticosteroid treatment for autoimmune pancreatitis. Gut. 2007;56:1650–2.
Chari ST. Autoimmune pancreatitis, part II: the relapse. Gastroenterology. 2008;134:625–8.
Nakazawa T, Ohara H, Sano H, Ando T, Joh T. Schematic classification of sclerosing cholangitis with autoimmune pancreatitis by cholangiography. Pancreas. 2006;32:229.
Ito T, Nishimori I, Inoue N, Kawabe K, Gibo J, Arita Y, et al. Treatment for autoimmune pancreatitis: consensus on the treatment for patients with autoimmune pancreatitis in Japan. J Gastroenterol. 2007;24(Suppl 18):50–8.
Unno H, Saegusa H, Fukushima M, Hamano H. Usefulness of endoscopic observation of the main duodenal papilla in the diagnosis of sclerosing pancreatitis. Gastrointest Endosc. 2002;56:880–4.
Nishimori I, Tamakoshi A, Kawa S, Tanaka S, Takeuti K, Kamisawa T, et al. Influence of steroid therapy on the course of diabetes mellitus in patients with autoimmune pancreatitis: findings from a nationwide survey in Japan. Pancreas. 2006;32:244–8.
Ito T, Kawabe K, Arita Y, Hisano T, Igarashi H, Funakoshi A, et al. Evaluation of pancreatic endocrine function in patients with autoimmune pancreatitis. Pancreas. 2006;34:254–9.
Uchida K, Yazumi S, Nishio A, Kusuda T, Koyabu M, Furuta M, et al. Long-term outcome of autoimmune pancreatitis. J Gastroenterol. 2009;44:726–32.
Tomiyama T, Uchida K, Matsushita M, Ikeura T, Fukui T, Takaoka M, et al. Comparison of steroid pulse therapy and conventional oral steroid therapy as initial treatment for autoimmune pancreatitis. J Gastroenterol. 2009;44:726–32.
Kamisawa T, Okazaki K, Kawa S, Shimosegawa T, Tanaka M, working members of research committee for intractable pancreatic disease and Japan Pancreas Society. Japanese consensus guidelines for management of autoimmune pancreatitis: III. Treatment and prognosis of AIP. J Gastroenterol. 2010;45:471–7.
Park DH, Kim MH, Oh HB, Kwon OJ, Choi YJ, Lee SS, et al. Substitution of aspartic acid at position 57 of the DQβ1 affects relapse of autoimmune pancreatitis. Gastroenterology. 2008;134:440–6.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kubota, K., Watanabe, S., Uchiyama, T. et al. Factors predictive of relapse and spontaneous remission of autoimmune pancreatitis patients treated/not treated with corticosteroids. J Gastroenterol 46, 834–842 (2011). https://doi.org/10.1007/s00535-011-0393-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00535-011-0393-y