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• W1965405321 abstract "Background: The majority of cases with autoimmune pancreatitis (AIP) respond well to steroid therapy, some cases show spontaneous remission, while others develop a refractory course. The clinical differences between these three types of AIP have not yet been fully elucidated. Aim: To study the clinicopathological differences among the three aforementioned types of AIP. Patients and Methods: Thirty-one consecutive patients of AIP who underwent ERCP between April 2001 and November 2007 were identified from our database. The patients were stratified by the serum IgG4 level into three subtypes. (Group A: IgG4 < 135 mg/dl; B:IgG4 135-1000 mg/dl; C: IgG4 > 1000 mg/dl). We conducted a retrospective review to determine whether the following factors might be useful in distinguishing among the three subgroups of patients with AIP; serological data, presence/absence of obstructive jaundice, presence/absence of sclerosing cholangitis affecting the hilar bile duct, duodenal papillary findings (presence/absence of swelling), distribution of the pancreatic swelling (local/diffuse), and presence/absence of complicating extrapancreatic lesions. The histopathological differences in the duodenal papilla were also examined. Results: There were 11, 17 and 3 patients, respectively, in Groups A, B and C. Group C showed a younger onset, with a higher frequency of bronchial asthma, sclerosing sialadenitis, sclerosing cholangitis and relapse. The results of univariate analysis revealed that group C patients were significantly younger (Group A, 68 years; B, 68 years; C, 50 years), and showed significantly higher frequencies of a swollen duodenal papilla (Group A, 9%; B, 76.4%; C, 100%) and diffuse pancreatic swelling (Group A, 0%; B, 52.9%; C, 100%) (p < 0.05). Histopathological examination revealed marked stromal lymphoplasmocytic infiltration with an abundance of IgG4-positive plasma cells (cells / high power field) in the duodenal papilla in group C (Group A, 3/HPF; B, 17/HPF; C, 25/HPF). Conclusions: Our results suggest that AIP can be classified into 3 subgroups; AIP cases showing spontaneous remission, those with typical AIP responding to steroid therapy, and those with refractory AIP showing high titers of serum IgG4, younger onset, and high frequencies of bronchial asthma, swelling of the duodenal papilla with abundant IgG4-positive plasma cell infiltration, sclerosing sialadenitis and diffuse pancreatic swelling. This last group of AIP patients should be distinguished from those with typical AIP and should be treated with great caution because of the high frequency of relapse in these patients. Towards this end, examination of the duodenal papilla may pay rich dividends." @default.
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• W1965405321 date "2008-04-01" @default.
• W1965405321 modified "2023-09-26" @default.
• W1965405321 title "Three Clinicopathological Subtypes of Autoimmune Pancreatitis Stratified By the Duodenal Papillary Findings and the Serum IgG4" @default.
• W1965405321 doi "https://doi.org/10.1016/j.gie.2008.03.985" @default.
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