title: Long-term prognosis of autoimmune pancreatitis with and without corticosteroid treatment.
abstract: OBJECTIVE
  Autoimmune pancreatitis (AIP) is a unique form of chronic pancreatitis, and has a favourable response to corticosteroid treatment (CST). Little is known, however, about the long-term outcome of AIP. This study aimed to document the prognosis without and with CST, and to examine the indication for CST.
  
  
  METHODS
  The prognosis and clinical features of 23 patients without CST and 19 patients treated with CST from onset were investigated. In addition, factors concerning the late occurrence of unfavourable events related to AIP were examined.
  
  
  RESULTS
  The patients without CST were 19 men and four women, with an average age of 66 years. After an average observation period of 25 months, 16 patients (70%) developed unfavourable events including obstructive jaundice as a result of distal bile duct stenosis in four, growing pseudocyst in one, sclerogenic changes of extrapancreatic bile duct in nine, hydronephrosis as a result of retroperitoneal fibrosis in one, and interstitial nephritis in one. 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 three women, with an average age of 64 years. After an average observation period of 23 months, six patients (32%) developed unfavourable events consisting of interstitial pneumonia in three, and a recurrence of obstructive jaundice in three. In multivariate analysis, CST (HR 0.33, 95% CI 0.12-0.89, p = 0.029) and obstructive jaundice at onset (HR 3.09, 95% CI 1.14-8.32, p = 0.026) were significant predictive factors for unfavourable events.
  
  
  CONCLUSIONS
  CST could reduce AIP-related unfavourable events. The early introduction of CST is recommended especially for patients with obstructive jaundice.
authors.affiliation: Department of Gastroenterology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. khirano-tky@umin.ac.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirano
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yagioka
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kogure
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Naoki
authors.initials: N
authors.lastname: Sasahira
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yoshida
authors.forename: Takao
authors.initials: T
authors.lastname: Kawabe
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D049448:Cholangiopancreatography, Magnetic Resonance; D015209:Cholangitis, Sclerosing / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids