Special Article

Journal of Gastroenterology

, Volume 43, Issue 6, pp 403-408

Asian diagnostic criteria for autoimmune pancreatitis: consensus of the Japan-Korea Symposium on Autoimmune Pancreatitis

  • Makoto OtsukiAffiliated withDepartment of Gastroenterology and Metabolism, University of Occupational and Environmental Health, Japan, School of Medicine
  • , Jae Bock ChungAffiliated withDepartment of Internal Medicine, Division of Gastroenterology, Yonsei University College of Medicine
  • , Kazuichi OkazakiAffiliated withThe Third Department of Internal Medicine, Kansai Medical University
  • , Myung-Hwan KimAffiliated withDepartment of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center
  • , Terumi KamisawaAffiliated withDepartment of Internal Medicine, Tokyo Metropolitan Komagome Hospital
  • , Shigeyuki KawaAffiliated withCenter for Health, Safety and Environmental Management, Shinshu University
  • , Seung Woo ParkAffiliated withDepartment of Internal Medicine, Division of Gastroenterology, Yonsei University College of Medicine
  • , Tooru ShimosegawaAffiliated withDepartment of Gastroenterology, Tohoku University, Graduate School of Medicine
  • , Kyutaek LeeAffiliated withDepartment of Medicine, School of Medicine, Sungkyunkwan University, Samsung Medical Center
    • , Tetsuhide ItoAffiliated withDepartment of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
    • , Isao NishimoriAffiliated withDepartment of Gastroenterology and Metabolism, University of Occupational and Environmental Health, Japan, School of MedicineDepartment of Gastroenterology and Hepatology, Kochi Medical School
    • , Kenji NotoharaAffiliated withDepartment of Gastroenterology and Metabolism, University of Occupational and Environmental Health, Japan, School of MedicineDepartment of Pathology, Kurashiki Central Hospital
    • , Satoru NaruseAffiliated withDepartment of Gastroenterology and Metabolism, University of Occupational and Environmental Health, Japan, School of MedicineDepartment of Gastroenterology, Nagoya University, Graduate School of Medicine
    • , Shigeru B. H. KoAffiliated withDepartment of Gastroenterology and Metabolism, University of Occupational and Environmental Health, Japan, School of MedicineDepartment of Gastroenterology, Nagoya University, Graduate School of Medicine
    • , Yasuyuki KiharaAffiliated withDepartment of Gastroenterology and Metabolism, University of Occupational and Environmental Health, Japan, School of Medicine
    • , the Research Committee of Intractable Pancreatic Diseases provided by the Ministry of Health, Labour and Welfare of Japan and the Korean Society of Pancreatobiliary Diseases

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Abstract

In 2002, the Japan Pancreas Society (JPS) was the first in the world to propose diagnostic criteria for autoimmune pancreatitis (AIP). Since the concept of AIP has changed with the accumulation of AIP cases, the Research Committee of Intractable Pancreatic Diseases (RCIPD) provided by the Ministry of Health, Labour and Welfare of Japan and the JPS issued revised clinical diagnostic criteria of AIP in 2006. The Asan Medical Center of Korea also proposed diagnostic criteria for AIP in 2006. However, there are subtle but clinically challenging differences between the Japanese and Korean criteria. This inconsistency makes it difficult to compare data in studies from different centers and elucidate the characteristics of AIP. To reach a consensus on AIP, the RCIPD and the Korean Society of Pancreatobiliary Diseases established the following Asian criteria for the diagnosis of AIP: I-1. Imaging studies of pancreatic parenchyma show a diffuse/segmental/focally enlarged gland, occasionally with a mass and/or a hypoattenuation rim. I-2. Imaging studies of pancreaticobiliary ducts show diffuse/segmental/focal pancreatic ductal narrowing, often with stenosis of the bile duct. (Both I-1 and I-2 are required for diagnosis). II. Elevated level of serum IgG or IgG4, and detection of autoantibodies. III. Common lymphoplasmacytic infiltration and fibrosis, with abundant IgG4-positive cell infiltration. AIP should be diagnosed when criterion I and one of the other two criteria are satisfied, or when histology shows the presence of lymphoplasmacytic sclerosing pancreatitis in the resected pancreas. A diagnostic trial of steroid therapy can be applied carefully by expert pancreatologists only in patients fulfilling criterion I alone with negative diagnostic work-up results for pancreatobiliary cancer.

Key words

autoimmune pancreatitis Asian diagnostic criteria imaging study IgG4 steroid therapy