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autoimmune pancreatitis:Cornerstones and future perspectives

World Journal of Gastroenterology 2024年第8期30卷 817-832页

作者： Camilla Gallo Giulia Dispinzieri Nicola Zucchini Pietro Invernizzi Sara Massironi Division of Gastroenterology and Center for autoimmune Liver Diseases Department of Medicine and SurgeryFondazione IRCCS San Gerardo dei TintoriUniversity of Milano-BicoccaMonza 20900Italy Department of Pathology Fondazione IRCCS San Gerardo dei TintoriMonza 20900Italy

autoimmune pancreatitis(AIP)is an autoimmune subtype of chronic pancreatitis resulting from the aberrant immune response against the pancreas,leading to inflammation and *** AIP is rare,its incidence is increasing and is often misdiagnosed as other pancreatic *** is commonly classified into two *** 1 AIP(AIP-1)is typically associated with elevated serum immunoglobulin G4(IgG4)levels and systemic manifestations,while type 2 AIP is typically a more localized form of the disease,and may coexist with other autoimmune disorders,especially inflammatory bowel ***,there is emerging recognition of a third type(type 3 AIP),which refers to immunotherapy-triggered AIP,although this classification is still gaining acceptance in medical *** clinical manifestations of AIP mainly include painless jaundice and weight *** serum IgG4 levels are particularly characteristic of *** relies on a combination of clinical,laboratory,radiological,and histological findings,given the similarity of AIP symptoms to other pancreatic *** mainstay of treatment for AIP is steroid therapy,which is effective in most *** cases might require additional imm-unosuppressive *** review aims to summarize the current knowledge of AIP,encompassing its epidemiology,etiology,clinical presentation,diagnosis,and treatment *** also address the challenges and controversies in diagnosing and treating AIP,such as distinguishing it from pancreatic cancer and managing long-term treatment,highlighting the need for increased awareness and knowledge of this complex disease.

关键词： Autoimmunity pancreatitis autoimmune pancreatitis Immunoglobulin G4 Steroids Relapse

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Understanding autoimmune pancreatitis: Clinical features, management challenges, and association with malignancies

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World Journal of Gastroenterology 2024年第15期30卷 2091-2095页

作者： Grigorios Christodoulidis Marina Nektaria Kouliou Konstantinos Eleftherios Koumarelas Department of General Surgery University Hospital of LarissaUniversity of ThessalyLarissa 41110Greece

In this editorial we comment on the article by Jaber et *** pancreatitis(AIP)represents a distinct form of pancreatitis,categorized into AIP-1 and AIP-2,characterized by obstructive jaundice,lymphoplasmacytic infiltrate,and ***-1,associated with elevated immunoglobulin G4(IgG4)levels,exhibits higher relapse rates,affecting older males,while AIP-2 is less common and linked to inflammatory bowel *** is considered a manifestation of IgG4-related systemic disease,sharing characteristic histological *** are the primary treatment,with emerging biomarkers like interferon alpha and *** poses an increased risk of various malignancies,and the assoc-iation with pancreatic cancer is *** is reserved for severe cases,necessitating careful evaluation due to diagnostic *** patients may have concurrent PanINs but display favorable long-term outcomes compared to pancreatic cancer *** diagnostic assessment,including biopsy and steroid response,is crucial for informed surgical decisions in AIP.

关键词： autoimmune pancreatitis Immunoglobulin G4-related disease Pancreatic cancer Surgery

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Can serum immunoglobulin G4 levels and age serve as reliable predictors of relapse in autoimmune pancreatitis?

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World Journal of Gastroenterology 2024年第5期30卷 512-515页

作者： Jun-Min Song Si-Yu Sun Department of Gastroenterology Shengjing Hospital of China Medical UniversityShenyang 110004Liaoning ProvinceChina

We are writing in response to the paper published in the World Journal of Gastroenterology by Zhou et *** authors identified higher serum immunoglobulin(Ig)G4 levels and age over 55 years as independent risk factors for disease *** notable strengths,it is crucial to address potential ***,the cohort study included 189 patients with autoimmune pancreatitis(AIP)type 1(with higher IgG4 seropositivity and higher relapse)and 24 with type 2(with lower IgG4 seropositivity and lower relapse).Consequently,most,if not all,AIP type 2 patients were assigned to the normal group,possibly inflating the association of higher serum IgG4 levels with relapse and potentially exaggerating the association of older age with ***,the authors did not provide sufficient details regarding AIP diagnosis,such as the ratio of definitive vs probable cases and the proportion of *** cases where histological evidence is unavailable or indeterminate,AIP type 2 may be misdiagnosed as definitive type 1,and type 1 may also be misdiagnosed as probable type 2,particularly in cases with normal or mildly elevated serum IgG4 ***,in this retrospective study,approximately one-third of the consecutive patients initially collected were excluded for various ***,the impact of nonrandom exclusion on relapse outcomes should be carefully *** conclusion,the paper by Zhou et al offers plausible,though not entirely compelling,evidence suggesting a predictive role of elevated serum IgG4 levels and advanced age in AIP *** foundation for future investigations lies in ensuring a reliable diagnosis and accurate disease subtyping,heavily dependent on obtaining histological *** this regard,endoscopic ultrasound-guided fine-needle biopsy emerges as a pivotal component of the diagnostic process,contributing to mitigating biases in future explorations of the disease.

关键词： autoimmune pancreatitis Immunoglobulin Endoscopic ultrasound Relapse Age

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Type one autoimmune pancreatitis based on clinical diagnosis: A case report

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World Journal of Clinical Cases 2024年第14期12卷 2438-2444页

作者： Bi-Yu Zhang Mou-Wang Liang Shuang-Xi Zhang Department of Gastroenterology Guangzhou University of Chinese Medicine Shunde HospitalFoshan 528300Guangdong ProvinceChina Department of Gastroenterology Guangzhou University of Chinese MedicineGuangzhou 510006Guangdong ProvinceChina

BACKGROUND autoimmune pancreatitis(AIP)is a rare form of autoimmune-mediated pancrea-titis,which is easily misdiagnosed as pancreatic cancer and thus treated *** studied the diagnosis and treatment of a patient with type 1 AIP recent-ly admitted to our hospital,and reviewed the literature to provide a reference for clinical diagnosis of *** SUMMARY The chief complaint was yellowing of the body,eyes and urine for 21 *** pa-tient's clinical presentation was obstructive jaundice and imaging suggested pan-creatic *** was difficult to distinguish between inflammation and *** immunoglobulin G4(IgG4)was markedly ***4 is an important serological marker for type 1 *** patient was diagnosed with AIP,IgG4-related cholangitis,acute cholecystitis and hepatic *** applying hormonal therapy,the patient's symptoms improved *** the same time,imaging suggested that pancreatic swelling subsided,and liver function and other biochemical indicators *** treatment was *** In patients with pancreatic swelling,the possibility of AIP should be considered.

关键词： autoimmune pancreatitis Characteristics Diagnosis Immunoglobulin G4 Case report

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Unmet needs in biomarkers for autoimmune pancreatitis diagnosis

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World Journal of Gastroenterology 2024年第6期30卷 523-526页

作者： Bao-Can Wang Jian-Gao Fan Department of Gastroenterology Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200092China

autoimmune pancreatitis(AIP)is a rare chronic autoimmune *** diagnosis of AIP mainly depends on histopathology,imaging and response to *** immunoglobulin 4(IgG4)is used only as collateral evidence in diagnostic criteria for AIP because of its moderate *** IgG4 levels are normal in 15%-37%of type 1 AIP and most of type 2 AIP *** these patients,the indeterminate imaging and histopathology may lead to the difficulty in definitive diagnosis of ***,discovery of new biomarkers is impor-tant for AIP ***,we provide some views on the progression and challenges in identifying novel serological biomarkers in AIP diagnosis.

关键词： autoimmune pancreatitis Immunoglobulin G4 Biomarker,Cytokine Autoantibody

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Glucocorticoid therapy in pancreatic portal hypertension associated with autoimmune pancreatitis:A case report

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World Journal of Clinical Cases 2024年第22期12卷 5184-5188页

作者： Yi Zhang Zhao-Dong Li Yuan-Jing He Wei Peng Yu-Jun Luo Xiao-An Li Department of Gastroenterology Mianyang Central HospitalMianyang 621000Sichuan ProvinceChina

BACKGROUND autoimmune pancreatitis(AIP)is a chronic form of pancreatitis characterized by diffused enlargement of the pancreas and irregular stenosis of the main pancreatic *** studies have reported that AIP can cause hemorrhage of gastric varices(GV)related to portal hypertension(PH).However,such cases are *** addition,the association of PH with AIP is *** the same time,the efficacy and duration of glucocorticoid therapy is also *** SUMMARY In this case,we reported a case of GV in pancreatic PH associated with *** abdominal computed tomography(CT)suggested splenic vein(SV)and superior mesenteric vein(SMV)*** patient received a long-term glucocorticoid therapy,that the initial dose of 40 mg is reduced weekly by 5 mg,and then reduced to 5 mg for long-term *** and gastroscopic examination after 8 mo of treatment indicated that SV and SMV were recanalized,pancreatic stiffness and swelling were ameliorated,and the GV almost completely *** Long-term glucocorticoid therapy can alleviate the development of GV in patients with AIP and has potential reversibility.

关键词： autoimmune pancreatitis Pancreatic portal hypertension Gastric varices Glucocorticoid therapy Case report

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autoimmune pancreatitis with different clinical manifestations and imaging findings:a series of three cases

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Journal of Pancreatology 2023年第2期6卷 82-86页

作者： Changhao Gao Zhiyao Fan Hanxiang Zhan Division of Pancreatic Surgery Department of General SurgeryQilu Hospital of Shandong UniversityJinanShandong ProvinceChina

autoimmune pancreatitis(AIP)is a rare and emerging immune-mediated *** involvement of the pancreas with lymph-oplasmacytic infiltration and fibrosis on histology is the most common features and has been well studied in the *** is characterized by a nonspecific presentation that mimics a malignant *** purpose of this report is to explore the different clinical and paraclinical aspects of this disease,as well as the challenges posed by its *** series are made up of three different cases of patients with elevated serum IgG4 levels and pancreatic *** first case initially revealed cholestatic jaundice with extrahepatic and intrahepatic cholangitis,and ultrasound reflected multiple occupying changes in the *** elevated serum IgG4 level was *** improved under the influence of *** second case was clinically asymptomatic,just found weight *** resonance revealed a round mass in the head of the pancreas and was considered as a neuroendocrine *** patient showed slightly elevated serum IgG4 level,but was sensitive to hormone *** third case concerned epigastric pain and enlarged lymph *** was initially diagnosed as pancreatic cancer with distant metastasis,but also finally resolved by corticosteroid *** clinical presentation of AIP is heterogeneous,as evidenced by our three clinical *** observational and interventional studies are needed to better identify and manage this disease.

关键词： autoimmune pancreatitis Clinical manifestation IgG4 Imaging finding

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Nonfunctional pancreatic neuroendocrine tumours misdiagnosed as autoimmune pancreatitis:A case report and review of literature

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World Journal of Clinical Cases 2022年第15期10卷 4886-4894页

作者： Zi-Qi Lin Xin Li Yan Yang Yi Wang Xiao-Ying Zhang Xiao-Xin Zhang Jia Guo Department of Integrated Traditional Chinese and Western Medicine Sichuan Provincial Pancreatitis Centre and West China-Liverpool Biomedical Research CentreWest China HospitalSichuan UniversityChengdu610041Sichuan ProvinceChina Laboratory Medicine West China School of MedicineSichuan UniversityChengdu 610041Sichuan ProvinceChina Department of Radiology West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina

BACKGROUND Nonfunctional pancreatic neuroendocrine tumours are difficult to diagnose in the early stage of disease due to a lack of clinical symptoms,but they can rarely manifest as autoimmune *** pancreatitis is an uncommon disease that may cause recurrent acute pancreatitis and is therefore often regarded as a special type of chronic *** SUMMARY We report a case of a 42-year-old female who had nonspecific upper abdominal pain for 4 years and radiological abnormalities of the pancreas that mimicked autoimmune *** symptoms and pancreatic imaging did not improve following 1 year of steroid ***,pancreatic biopsy was performed through endoscopic ultrasonography-guided fine-needle aspiration biopsy,and nonfunctional pancreatic neuroendocrine tumours were ultimately *** has resolved her *** Therefore,the differentiation of nonfunctional pancreatic neuroendocrine tumours from autoimmune pancreatitis is very important,although it is *** propose that endoscopic ultrasonography-guided fine-needle aspiration biopsy should be performed if imaging characteristics are equivocal or the diagnosis is in question.

关键词： Pancreatic neuroendocrine tumour Nonfunctional pancreatic neuroendocrine tumour autoimmune pancreatitis Endoscopic ultrasonography-guided fine needle aspiration biopsy Case report

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Diagnostic value of imaging examination in autoimmune pancreatitis

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World Journal of Clinical Cases 2022年第33期10卷 12458-12461页

作者： Fang Wang Yun Peng Bo Xiao Department of Radiology Affiliated Hospital of North Sichuan Medical CollegeNanchong 637000Sichuan ProvinceChina Department of Radiology The Hospital of Chinese Traditional Medicine of LeshanLeshan 614000Sichuan ProvinceChina

autoimmune pancreatitis(AIP)is a special type of chronic pancreatitis mediated by autoimmunity *** can be divided into two categories according to pathological characteristics:Lymphoplasmacytic sclerosing pancreatitis and idiopathic duct-centric *** the clinical setting,the imaging manifestations of some AIP cases are atypical,so it is difficult to distinguish it from general pancreatitis,pancreatic ductal adenocarcinoma,lymphoma,and other malignant *** importantly,the treatment for and prognosis of these diseases are ***,a timely correct imaging diagnosis of AIP is key for AIP *** that,clinicians can take appropriate treatment measures for those patients,which is helpful for the prognosis of AIP.

关键词： autoimmune pancreatitis Diagnosis Computed tomography Magnetic resonance imaging Pancreatic cancer

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Challenges for clinicians treating autoimmune pancreatitis:Current perspectives

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World Journal of Clinical Cases 2023年第1期11卷 30-46页

作者： Seong-Hun Kim Yun Chae Lee Hyung Ku Chon Division of Gastroenterology Department of Internal MedicineJeonbuk National University Medical SchoolJeonju 54907South Korea Department of Internal Medicine Institution of Wonkwang Medical ScienceWonkwang University School of Medicine and HospitalIksan 54538South Korea

autoimmune pancreatitis(AIP)is a rare disease clinically characterized by obstructive jaundice,unintentional weight loss,acute pancreatitis,focal pancreatic mass,and *** is classified into two subtypes-type 1 and type 2-according to pathological findings,clinical features,and serology test results,but some cases may be defined as type not otherwise in the absence of pathological findings and inflammatory bowel *** address the differences in diagnostic criteria by country,standard diagnostic criteria for AIP were proposed in 2011 by an international consensus of expert *** diagnosis of AIP from pancreatic ductal adenocarcinoma is important but remains challenging for ***,all subtypes of AIP show dramatic response to steroid *** review discusses the current perspectives on the diagnosis and management of AIP in clinical practice.

关键词： autoimmune pancreatitis Pancreatic cancer International consensus diagnostic criteria Steroid

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