title: Autoimmune Pancreatitis.
abstract: Autoimmune pancreatitis (AIP) is a chronic fibroinflammatory disease of the pancreas that belongs to the spectrum of immunoglobulin G-subclass4-related diseases (IgG4-RD) and typically presents with obstructive jaundice. Idiopathic duct-centric pancreatitis (IDCP) is a closely related but distinct disease that mimics AIP radiologically but manifests clinically most commonly as recurrent acute pancreatitis in young individuals with concurrent inflammatory bowel disease. IgG4 levels are often elevated in AIP and normal in IDCP. Histologically, lymphoplasmacytic acinar inflammation and storiform fibrosis are seen in both. In addition, the histologic hallmark of IDCP is the granulocyte epithelial lesion: intraluminal and intraepithelial neutrophils in medium-sized and small ducts with or without granulocytic acinar inflammation often associated with destruction of ductal architecture. Initial treatment of both AIP and IDCP is with oral corticosteroids for duration of 4 weeks followed by a gradual taper. Relapses are common in AIP and relatively uncommon in IDCP, a relatively rare disease for which the natural history is not well understood. For patients with relapsing AIP, treatment with immunomodulators and more recently rituximab has been recommended. Although rare instances of pancreaticobiliary malignancy has been reported in patients with AIP, overall the lifetime risk of developing pancreatic cancer does not appear to be elevated.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors.forename: Shounak
authors.initials: S
authors.lastname: Majumder
authors.affiliation: Division of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Naoki
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. chari.suresh@mayo.edu.
authors.forename: Suresh T
authors.initials: ST
authors.lastname: Chari
mesh_terms: D001327:Autoimmune Diseases / Q000150:complications / Q000473:pathology*; D010188:Exocrine Pancreatic Insufficiency / Q000209:etiology; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism*; D010195:Pancreatitis / Q000150:complications / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D013256:Steroids / Q000627:therapeutic use
chemical_list: D007074:Immunoglobulin G; D013256:Steroids
keywords: Autoimmune pancreatitis; Corticosteroids; Idiopathic duct-centric pancreatitis; Immunomodulator; Medical management; Relapse; Rituximab