Skip to main content

Prognosis

  • Chapter
  • First Online:
IgG4-Related Sclerosing Cholangitis

Abstract

IgG4-related sclerosing cholangitis (IgG4-SC) is a biliary manifestation of a systemic condition known as IgG4-related disease (IgG4-RD). IgG4-RD may involve various organs with type 1 autoimmune pancreatitis (AIP) being the leading manifestation. Older men are more affected by IgG4-SC than women (ratio of 4:1), and the most common clinical manifestation is obstructive jaundice. The pathogenic mechanism of IgG4-SC remains unclear. Steroid therapy can lead to clinical and radiological improvement when provided in the inflammatory phase of this disease. However, long-term outcome data in patients with IgG4-SC are lacking. In this chapter, we focus on the prognosis of IgG4-SC, including the natural course, treatment response, risk of malignancy, and long-term outcome, based on current evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Okazaki K, Uchida K, Koyabu M, Miyoshi H, Ikeura T, Takaoka M. IgG4 cholangiopathy: current concept, diagnosis, and pathogenesis. J Hepatol. 2014;61:690–5.

    Article  CAS  PubMed  Google Scholar 

  2. Nakazawa T, Ohara H, Sano H, Ando T, Joh T. Schematic classification of sclerosing cholangitis with autoimmune pancreatitis by cholangiography. Pancreas. 2006;32:229.

    Article  PubMed  Google Scholar 

  3. Culver EL, Chapman RW. IgG4-related hepatobiliary disease: an overview. Nat Rev Gastroenterol Hepatol. 2016;13:601–12.

    Article  CAS  PubMed  Google Scholar 

  4. Kamisawa T, Yoshiike M, Egawa N, Nakajima H, Tsuruta K, Okamoto A. Treating patients with autoimmune pancreatitis: results from a long-term follow-up study. Pancreatology. 2005;5:234–40.

    Article  PubMed  Google Scholar 

  5. Kubota K, Iida H, Fujisawa T, Yoneda M, Inamori M, Abe Y, et al. Clinical factors predictive of spontaneous remission or relapse in cases of autoimmune pancreatitis. Gastrointest Endosc. 2007;66:1142–51.

    Article  PubMed  Google Scholar 

  6. Khosroshahi A, Wallace ZS, Crowe JL, Akamizu T, Azumi A, Carruthers MN, et al. Second international symposium on IgG4-related disease. International consensus guidance statement on the management and treatment of IgG4-related disease. Arthritis Rheumatol. 2015;67:1688–99.

    Article  CAS  PubMed  Google Scholar 

  7. Kamisawa T, Shimosegawa T, Okazaki K, Nishino T, Watanabe H, Kanno A, et al. Standard steroid treatment for autoimmune pancreatitis. Gut. 2009;58:1504–7.

    Article  CAS  PubMed  Google Scholar 

  8. Ghazale A, Chari ST, Zhang L, Smyrk TC, Takahashi N, Levy MJ, et al. Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy. Gastroenterology. 2008;134:706–15.

    Article  PubMed  Google Scholar 

  9. Sandanayake NS, Church NI, Chapman MH, Johnson GJ, Dhar DK, Amin Z, et al. Presentation and management of post-treatment relapse in autoimmune pancreatitis/immunoglobulin G4-associated cholangitis. Clin Gastroenterol Hepatol. 2009;7:1089–96.

    Article  CAS  PubMed  Google Scholar 

  10. Huggett MT, Culver EL, Kumar M, Hurst JM, Rodriguez-Justo M, Chapman MH, et al. Type 1 autoimmune pancreatitis and IgG4-related sclerosing cholangitis is associated with extrapancreatic organ failure, malignancy, and mortality in a prospective UK cohort. Am J Gastroenterol. 2014;109:1675–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Hart PA, Kamisawa T, Brugge WR, Chung JB, Culver EL, Czakó L, et al. Long-term outcomes of autoimmune pancreatitis: a multicentre, international analysis. Gut. 2013;62:1771–6.

    Article  PubMed  Google Scholar 

  12. Hart PA, Topazian MD, Witzig TE, Clain JE, Gleeson FC, Klebig RR, et al. Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab: the Mayo Clinic experience. Gut. 2013;62:1607–15.

    Article  CAS  PubMed  Google Scholar 

  13. Topazian M, Witzig TE, Smyrk TC, Pulido JS, Levy MJ, Kamath PS, et al. Rituximab therapy for refractory biliary strictures in immunoglobulin G4-associated cholangitis. Clin Gastroenterol Hepatol. 2008;6:364–6.

    Article  CAS  PubMed  Google Scholar 

  14. Zen Y, Kawakami H, Kim JH. IgG4-related sclerosing cholangitis: all we need to know. J Gastroenterol. 2016;51(4):295–312.

    Article  CAS  PubMed  Google Scholar 

  15. Shiokawa M, Kodama Y, Yoshimura K, Kawanami C, Mimura J, Yamashita Y, et al. Risk of cancer in patients with autoimmune pancreatitis. Am J Gastroenterol. 2013;108:610–7.

    Article  CAS  PubMed  Google Scholar 

  16. Hart PA, Law RJ, Dierkhising RA, Smyrk TC, Takahashi N, Chari ST. Risk of cancer in autoimmune pancreatitis: a case-control study and review of the literature. Pancreas. 2014;43:417–21.

    Article  PubMed  Google Scholar 

  17. Oh HC, Kim JG, Kim JW, Lee KS, Kim MK, Chi KC, et al. Early bile duct cancer in a background of sclerosing cholangitis and autoimmune pancreatitis. Intern Med. 2008;47:2025–8.

    Article  PubMed  Google Scholar 

  18. Straub BK, Esposito I, Gotthardt D, Radeleff B, Antolovic D, Flechtenmacher C, et al. IgG4-associated cholangitis with cholangiocarcinoma. Virchows Arch. 2011;458:761–5.

    Article  PubMed  Google Scholar 

  19. Tanaka A, Tazuma S, Okazaki K, Tsubouchi H, Inui K, Takikawa H. Nationwide survey for primary sclerosing cholangitis and IgG4-related sclerosing cholangitis in Japan. J Hepatobiliary Pancreat Sci. 2014;21:43–50.

    Article  PubMed  Google Scholar 

  20. Hirano A, Nakazawa T, Ohara H, Ando T, Hayashi K, Tanaka H, et al. Liver atrophy and portal stenosis in two cases of sclerosing cholangitis associated with autoimmune pancreatitis. Intern Med. 2008;47:1689–94.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yuzo Kodama .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Science+Business Media Singapore

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kuwada, T., Shiokawa, M., Tomono, T., Uza, N., Kodama, Y. (2019). Prognosis. In: Kamisawa, T., Kim, MH. (eds) IgG4-Related Sclerosing Cholangitis. Springer, Singapore. https://doi.org/10.1007/978-981-10-4548-6_19

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-4548-6_19

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-4547-9

  • Online ISBN: 978-981-10-4548-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics