Treating patients with autoimmune pancreatitis: results from a long-term follow-up study.
BACKGROUND
Steroid therapy is currently common treatment for autoimmune pancreatitis (AIP); however, indications of steroid therapy have yet to be established, and the clinical course after steroid therapy is unknown.


METHODS
A total of 23 patients with AIP were subdivided into 4 groups according to the initial treatments undertaken. They were treated with pancreatoduodenectomy on suspicion of pancreatic tumor in 6 patients, choledochoduodenostomy with pancreatic biopsy in 4 patients, supportive therapy in 3 patients, and steroid therapy in 10 patients. Clinical course of AIP in each group was examined.


RESULTS
Prognosis of the AIP patients is almost good except for the 2 patients who progressed to pancreatic insufficiency after resection. Two patients without jaundice improved spontaneously. Steroid therapy was effective in all patients treated, but pancreatic atrophy developed in 5 of these patients. Steroid therapy improved insulin secretion and glycemic control in 4 of 7 diabetes mellitus (DM) patients.


CONCLUSIONS
To avoid futile surgery, in relatively elderly male patients with obstructive jaundice suggestive of pancreatic carcinoma, preoperative clinical suspicion of AIP is mandatory. Indications of steroid therapy for AIP are thought to be obstructive jaundice due to stenosis of the bile duct, other associated systemic autoimmune, and DM coincidental with AIP.
Kamisawa
Terumi
T
Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. kamisawa@cick.jp
Yoshiike
Masami
M
Egawa
Naoto
N
Nakajima
Hitoshi
H
Tsuruta
Kouji
K
Okamoto
Atsutake
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000601:surgery; D002768:Choledochostomy; D002908:Chronic Disease; D010188:Exocrine Pancreatic Insufficiency / Q000188:drug therapy / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D041781:Jaundice, Obstructive / Q000188:drug therapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D010195:Pancreatitis / Q000188:drug therapy* / Q000276:immunology* / Q000601:surgery; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome
D013256:Steroids