title: Diagnosis and treatment of autoimmune pancreatitis: experience with 100 patients.
abstract: BACKGROUND
  Autoimmune pancreatitis (AIP) is increasingly recognized as a unique subtype of pancreatitis. This study aimed to analyze the diagnosis and treatment of AIP patients from a tertiary care center in China.
  
  
  METHODS
  One hundred patients with AIP who had been treated from January 2005 to December 2012 in our hospital were enrolled in this study. We retrospectively reviewed the data of clinical manifestations, laboratory tests, imaging examinations, pathological examinations, treatment and outcomes of the patients.
  
  
  RESULTS
  The median age of the patients at onset was 57 years (range 23-82) with a male to female ratio of 8.1:1. The common manifestations of the patients included obstructive jaundice (49 patients, 49.0%), abdominal pain (30, 30.0%), and acute pancreatitis (11, 11.0%). Biliary involvement was one of the most extrapancreatic manifestations (64, 64.0%). Fifty-six (56.0%) and 43 (43.0%) patients were classified into focal-type and diffuse-type respectively according to the imaging examinations. The levels of serum IgG and IgG4 were elevated in 69.4% (43/62) and 92.0% (69/75) patients. Pathological analysis of specimens from 27 patients supported the diagnosis of lymphoplasmacytic sclerosing pancreatitis, and marked (>10 cells/HPF) IgG4 positive cells were found in 20 (74.1%) patients. Steroid treatment and surgery as the main initial treatments were given to 41 (41.0%) and 28 (28.0%) patients, respectively. The remission rate after the initial treatment was 85.0%. Steroid was given as the treatment after relapse in most of the patients and the total remission rate at the end of follow-up was 96.0%.
  
  
  CONCLUSIONS
  Clinical manifestations, laboratory tests, imaging and pathology examinations in combination could increase the diagnostic accuracy of AIP. Steroid treatment with an initial dose of 30 or 40 mg prednisone is effective and safe in most patients with AIP.
authors.affiliation: Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China. zhaoshenli@hotmail.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Xin
authors.forename: Yuan-Xiang
authors.initials: YX
authors.lastname: He
authors.forename: Xiao-Fei
authors.initials: XF
authors.lastname: Zhu
authors.forename: Qun-Hua
authors.initials: QH
authors.lastname: Zhang
authors.forename: Liang-Hao
authors.initials: LH
authors.lastname: Hu
authors.forename: Duo-Wu
authors.initials: DW
authors.lastname: Zou
authors.forename: Zhen-Dong
authors.initials: ZD
authors.lastname: Jin
authors.forename: Xue-Jiao
authors.initials: XJ
authors.lastname: Chang
authors.forename: Jian-Ming
authors.initials: JM
authors.lastname: Zheng
authors.forename: Chang-Jing
authors.initials: CJ
authors.lastname: Zuo
authors.forename: Cheng-Wei
authors.initials: CW
authors.lastname: Shao
authors.forename: Gang
authors.initials: G
authors.lastname: Jin
authors.forename: Zhuan
authors.initials: Z
authors.lastname: Liao
authors.forename: Zhao-Shen
authors.initials: ZS
authors.lastname: Li
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000974:Antibodies, Antinuclear / Q000097:blood; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy*; D004322:Drainage; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D041781:Jaundice, Obstructive / Q000209:etiology; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D010195:Pancreatitis / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy*; D011241:Prednisone / Q000627:therapeutic use*; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000974:Antibodies, Antinuclear; D007074:Immunoglobulin G; D011241:Prednisone