title: Comparison of steroid pulse therapy and conventional oral steroid therapy as initial treatment for autoimmune pancreatitis.
abstract: BACKGROUND
  The efficacy of oral steroid therapy for autoimmune pancreatitis (AIP) is well known, and oral prednisolone treatment is most usually commenced at 30-40 mg/day, but there have been few reports about comparative studies of oral steroid therapy and steroid pulse therapy as the initial treatment for AIP. We studied the clinical course and image findings to estimate the utility of steroid pulse therapy for AIP, comparing it with oral steroid therapy.
  
  
  METHODS
  Laboratory and image findings were assessed retrospectively in 11 patients who received steroid pulse therapy, and the findings were compared to those in 10 patients who received conventional oral steroid therapy.
  
  
  RESULTS
  Change in pancreatic size showed no significant difference between the therapies after 2 weeks of treatment. Significant improvement of lower bile duct strictures after 2 weeks of treatment and that of immunoglobulin values within 6 months were shown with both therapies. However, steroid pulse therapy showed significant improvement of γ-guanosine triphosphate (GTP) in 2 weeks and of alanine aminotransferase (ALT) in 2 and 8 weeks, compared with oral steroid therapy. Moreover, there was one patient in whom the lower bile duct stricture was not improved by oral steroid therapy, but it did show improvement with steroid pulse therapy.
  
  
  CONCLUSIONS
  Initial steroid pulse therapy is a beneficial alternative to oral steroid therapy for the improvement of bile duct lesions. In future, the accumulation of a larger number of patients receiving steroid pulse therapy is needed, and prospective studies will be required.
authors.affiliation: Division of Gastroenterology and Hepatology, the Third Department of Internal Medicine, Kansai Medical University, 10-15 Fumizono, Moriguchi, Osaka 570-8507, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tomiyama
authors.forename: Kazushige
authors.initials: K
authors.lastname: Uchida
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Matsushita
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ikeura
authors.forename: Toshiro
authors.initials: T
authors.lastname: Fukui
authors.forename: Makoto
authors.initials: M
authors.lastname: Takaoka
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Nishio
authors.forename: Kazuichi
authors.initials: K
authors.lastname: Okazaki
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000503:physiopathology; D001652:Bile Ducts / Q000473:pathology; D003251:Constriction, Pathologic / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D010195:Pancreatitis / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D020551:Pulse Therapy, Drug; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone; D008775:Methylprednisolone