Clinical course and indications for steroid therapy of sclerosing cholangitis associated with autoimmune pancreatitis.
OBJECTIVE
There have been only a few reports about the clinical course and indications for steroid therapy of autoimmune pancreatitis (AIP). We studied 45 cases of AIP to clarify the clinical course and indications for steroid therapy, from the viewpoint of associated sclerosing cholangitis (SC).


METHODS
Two groups (with and without progression or recurrence) were compared by cholangiographic classification, blood chemistry, initial therapy, presenting symptoms and pancreatic findings.


RESULTS
One patient with AIP and no stricture and seven patients with AIP and SC with stricture of the lower common bile duct showed strictures of the intrahepatic bile duct and hilar hepatic lesions during their clinical course. SC patients with intrahepatic stenosis showed higher IgG levels than those with stenosis of the lower common bile duct only. Six of seven cases without steroid therapy and IgG >2000 mg/dL showed significantly greater recurrence or progression of SC.


CONCLUSIONS
When a patient with SC and AIP with elevated levels of IgG (>2000 mg/dL) is encountered, steroid administration should be initiated immediately.
Nakazawa
Takahiro
T
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Ohara
Hirotaka
H
Ando
Tomoaki
T
Hayashi
Kazuki
K
Naitoh
Itaru
I
Okumura
Fumihiro
F
Tanaka
Hajime
H
Sano
Hitoshi
H
Joh
Takashi
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000150:complications*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000209:etiology / Q000473:pathology* / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications*; D018579:Patient Selection; D011239:Prednisolone / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D005938:Glucocorticoids; D011239:Prednisolone