title: Autoimmune pancreatitis - diagnosis, management and longterm follow-up.
abstract: OBJECTIVE
  Autoimmune pancreatitis (AIP) is a fibroinflammatory condition affecting the pancreas and could present as a multisystem disorder. Diagnosis and management can pose a diagnostic challenge in certain groups of patients. We report our experience of managing this condition in a tertiary pancreaticobiliary centre in the North East of England.
  
  
  METHODS
  Patients were identified from a prospectively maintained database of patients diagnosed with AIP between 2005 and 2013. Diagnosis of definite/probable AIP was based on the revised HISORt criteria. When indicated, patients were treated with steroids and relapses were treated with azathioprine. All patients have been followed up to date.
  
  
  RESULTS
  Twenty-two patients were diagnosed with AIP during this period. All patients had pancreatic protocol CT performed while some patients had either MR or EUS as part of the work up. Fourteen out of 22 (64%) had an elevated IgG4 level (mean: 10.9 g/L; range 3.4 - 31 g/L). Four (18%) patients underwent surgery. Extrapancreatic involvement was seen in 15 (68%) patients, with biliary involvement being the commonest. Nineteen (86%) were treated with steroids and five (23%) required further immunosuppression for treatment of relapses. The mean follow up period was 36.94 months (range 7 - 94).
  
  
  CONCLUSIONS
  Autoimmune pancreatitis is being increasingly recognized in the British population. Extrapancreatic involvement, particularly extrahepatic biliary involvement seems to be a frequent feature. Diagnosis should be based on accepted criteria as this significantly reduces the chances of overlooking malignancy. Awareness of this relatively rare condition and a multi-disciplinary team approach will help us to diagnose and treat this condition more effectively thereby reducing unnecessary interventions.
authors.affiliation: HPB Unit Freeman Hospital Newcastle-upon-Tyne United Kingdom. Manu.Nayar@nuth.nhs.uk.
authors.forename: Suvadip
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: HPB Unit Freeman Hospital Newcastle-upon-Tyne United Kingdom.
authors.forename: Kofi W
authors.initials: KW
authors.lastname: Oppong
authors.affiliation: HPB Unit Freeman Hospital Newcastle-upon-Tyne United Kingdom.
authors.forename: John S
authors.initials: JS
authors.lastname: Scott
authors.affiliation: HPB Unit Freeman Hospital Newcastle-upon-Tyne United Kingdom.
authors.forename: Dave E
authors.initials: DE
authors.lastname: Jones
authors.affiliation: HPB Unit Freeman Hospital Newcastle-upon-Tyne United Kingdom.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Charnley
authors.affiliation: HPB Unit Freeman Hospital Newcastle-upon-Tyne United Kingdom.
authors.forename: Derek M
authors.initials: DM
authors.lastname: Manas
authors.affiliation: HPB Unit Freeman Hospital Newcastle-upon-Tyne United Kingdom.
authors.forename: Byron C
authors.initials: BC
authors.lastname: Jaques
authors.affiliation: HPB Unit Freeman Hospital Newcastle-upon-Tyne United Kingdom.
authors.forename: Steve A
authors.initials: SA
authors.lastname: White
authors.affiliation: HPB Unit Freeman Hospital Newcastle-upon-Tyne United Kingdom.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: French
authors.affiliation: HPB Unit Freeman Hospital Newcastle-upon-Tyne United Kingdom.
authors.forename: Gourab S
authors.initials: GS
authors.lastname: Sen
authors.affiliation: HPB Unit Freeman Hospital Newcastle-upon-Tyne United Kingdom.
authors.forename: Beate
authors.initials: B
authors.lastname: Haugk
authors.affiliation: HPB Unit Freeman Hospital Newcastle-upon-Tyne United Kingdom.
authors.forename: Manu K
authors.initials: MK
authors.lastname: Nayar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000188:drug therapy; D001649:Bile Duct Diseases / Q000150:complications / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed
chemical_list: D005938:Glucocorticoids; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents