Journal of Gastroenterology

, Volume 42, Supplement 18, pp 50–58

Treatment for autoimmune pancreatitis: consensus on the treatment for patients with autoimmune pancreatitis in Japan

  • Tetsuhide Ito
  • Isao Nishimori
  • Naoko Inoue
  • Ken Kawabe
  • Junya Gibo
  • Yoshiyuki Arita
  • Kazuichi Okazaki
  • Ryoichi Takayanagi
  • Makoto Otsuki
Treatment

Abstract

Autoimmune pancreatitis (AIP) has been characterized by unique clinical imaging, immunological findings, and the effectiveness of steroid therapy. A set of clinicopathological criteria for AIP was proposed by the Japan Pancreatic Society in 2002, and AIP has come to be widely recognized among general digestive clinicians. However, the indication of steroid therapy for AIP is still not well established, and furthermore the therapeutic doses and method of administration of steroid therapy is also unclear. Recently, an epidemiological survey of all the treatments used for AIP in Japan was conducted by the Research Committee of Intractable Pancreatic Diseases, and their report “Consensus for a Treatment of Autoimmune Pancreatitis” was produced. In a comparison of the results of steroid therapy and nonsteroid therapy for AIP in relation to the rate of complete remission, the recurrence rate, and the period needed to guarantee complete remission, it was thought that the administration of a steroid should be a standard therapy for AIP. However, if the diagnosis of AIP is still uncertain, steroid therapy should be given with caution. In addition, even when AIP still appears to be possible after a course of steroid therapy, a re-evaluation should be carried out taking pancreatic carcinoma into consideration. An initial steroid dose of 30–40 mg per day is recommended. With continuous and careful observations of the clinical manifestations, laboratory data, and imaging findings after administration of the initial dose of steroid for 2–4 weeks, the quantity of steroid can be reduced gradually to a maintenance dose in 2–3 months, and then reduced to 2.5–5 mg per day after remission. The recommended period of maintenance treatment is still unclear, but the administration of the steroid could be stopped after a period of about 6–12 months of treatment, although the patient should be monitored for clinical manifestations of improvement. In addition, the patient's progress should be followed taking recurrence into consideration. In order to evaluate the effectiveness of steroid therapy, follow-up observations should include biochemical examinations of blood findings such as serum γ-globulin, IgG, and IgG 4, imaging findings, and clinical manifestations such as jaundice and abdominal discomfort.

Key words

autoimmune pancreatitis steroid therapy survey 

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References

  1. 1.
    Yoshida, K, Toki, F, Takeuchi, T, Watanabe, S, Shiratori, K, Hayashi, N 1995Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitisDig Dis Sci4015618PubMedCrossRefGoogle Scholar
  2. 2.
    Ito, T, Nakano, I, Koyanagi, S, Miyahara, T, Migita, Y, Ogoshi, K,  et al. 1997Autoimmune pancreatitis as a new clinical entity. Three cases of autoimmune pancreatitis with effective steroid therapyDig Dis Sci42145868PubMedCrossRefGoogle Scholar
  3. 3.
    Okazaki, K, Chiba, T 2002Autoimmune related pancreatitisGut5114PubMedCrossRefGoogle Scholar
  4. 4.
    Okazaki, K 2005Autoimmune pancreatitis: etiology, pathogenesis, clinical findings and treatment. The Japanese experienceJOP68996PubMedGoogle Scholar
  5. 5.
    Uchida, K, Okazaki, K, Konishi, Y, Ohana, M, Takakuwa, H, Hajiro, K,  et al. 2000Clinical analysis of autoimmune-related pancreatitisAm J Gastroenterol95278894PubMedCrossRefGoogle Scholar
  6. 6.
    Kamisawa, T, Funata, N, Hayashi, Y, Eishi, Y, Koike, M, Tsuruta, K,  et al. 2003A new clinicopathological entity of IgG4-related autoimmune diseaseJ Gastroenterol389824PubMedCrossRefGoogle Scholar
  7. 7.
    Hamano, H, Kawa, S, Horiuchi, A, Unno, H, Furuya, N, Akamatsu, T,  et al. 2001High serum IgG4 concentrations in patients with sclerosing pancreatitisN Engl J Med3447328PubMedCrossRefGoogle Scholar
  8. 8.
    Okazaki, K, Uchida, K, Ohana, M, Nakase, H, Uose, S, Inai, M,  et al. 2000Autoimmune-related pancreatitis is associated with autoantibodies and Th1/Th2-type cellular immune responseGastroenterology11857381PubMedCrossRefGoogle Scholar
  9. 9.
    Members of the Criteria Committee for Autoimmune Pancreatitis of the Japan Pancreatic Society2002Diagnostic criteria for autoimmune pancreatitis by the Japan Pancreas SocietyJ Jpn Pancreas Soc175857Google Scholar
  10. 10.
    Otsuki, M 2004Chronic pancreatitis. The problems of diagnostic criteriaPancreatology42841PubMedCrossRefGoogle Scholar
  11. 11.
    Nishimori, I, Okazaki, K, Suda, K, Kawa, S, Kamisawa, T, Tanaka, S,  et al. 2005Treatment for autoimmune pancreatitisJ Jpn Pancreas Soc203438CrossRefGoogle Scholar
  12. 12.
    Okazaki, K 2002Clinical relevance of autoimmune-related pancreatitisBest Pract Res Clin Gastroenterol1636578PubMedCrossRefGoogle Scholar
  13. 13.
    Tanaka, S, Kobayashi, T, Nakanishi, K, Okubo, M, Murase, T, Hashimoto, M,  et al. 2000Corticosteroid-responsive diabetes mellitus associated with autoimmune pancreatitisLancet3569101PubMedCrossRefGoogle Scholar
  14. 14.
    Klöppel, G, Luttges, J, Lohr, M, Zamboni, G, Longnecker, D 2003Autoimmune pancreatitis: pathological, clinical, and immunological featuresPancreas27149PubMedCrossRefGoogle Scholar
  15. 15.
    Kamisawa, T, Egawa, N, Inokuma, S, Tsuruta, K, Okamoto, A, Kamata, N,  et al. 2003Pancreatic endocrine and exocrine function and salivary gland function in autoimmune pancreatitis before and after steroid therapyPancreas272358PubMedCrossRefGoogle Scholar
  16. 16.
    Nishino, T, Toki, F, Oyama, H, Shimizu, K, Shiratori, K 2006Long-term outcome of autoimmune pancreatitis after oral predonisolone therapyIntern Med45497501PubMedCrossRefGoogle Scholar
  17. 17.
    Nishimori, I, Tamakoshi, A, Kawa, S, Tanaka, S, Takeuchi, K, Kamisawa, T,  et al. 2006Research Committee on Intractable Pancreatic Diseases, the Ministry of Health and Welfare of Japan. Influence of steroid therapy on the course of diabetes mellitus in patients with autoimmune pancreatitis: findings from a nationwide survey in JapanPancreas322448PubMedCrossRefGoogle Scholar
  18. 18.
    Kamisawa, T, Yoshiike, M, Egawa, N, Nakajima, H, Tsuruta, K, Okamoto, A 2005Treating patients with autoimmune pancreatitis: results from a long-term follow-up studyPancreatology523440PubMedCrossRefGoogle Scholar
  19. 19.
    Okazaki, K 2002Ursodeoxycholic acid as an alternative therapy for autoimmune pancreatitisIntern Med4110823PubMedGoogle Scholar
  20. 20.
    Tsubakio, K, Kiriyama, K, Matsushima, N, Taniguchi, M, Shizusawa, T, Katoh, T,  et al. 2002Autoimmune pancreatitis successfully treated with ursodeoxycholic acidIntern Med4111426PubMedGoogle Scholar
  21. 21.
    Portincasa, P, Vacca, M, Moschetta, A, Petruzzelli, M, Palasciano, G, van Erpecum, KJ,  et al. 2005Primary sclerosing cholangitis: updates in diagnosis and therapyWorld J Gastroenterol11716PubMedGoogle Scholar
  22. 22.
    Hirano, K, Shiratori, Y, Komatsu, Y, Yamamoto, N, Sasahira, N, Toda, N,  et al. 2003Involvement of the biliary system in autoimmune pancreatitis: a follow-up studyClin Gastroenterol Hepatol145364PubMedCrossRefGoogle Scholar
  23. 23.
    Nakazawa, T, Ohara, H, Sano, H, Ando, T, Aoki, S, Kobayashi, S,  et al. 2005Clinical differences between primary sclerosing cholangitis and sclerosing cholangitis with autoimmune pancreatitisPancreas30205PubMedGoogle Scholar
  24. 24.
    Nishino, T, Toki, F, Oyama, H, Oi, I, Kobayashi, M, Takasaki, K,  et al. 2005Biliary tract involvement in autoimmune pancreatitisPancreas307682PubMedGoogle Scholar
  25. 25.
    Nakazawa, T, Ohara, H, Sano, H, Aoki, S, Kobayashi, S, Okamoto, T,  et al. 2004Cholangiography can discriminate sclerosing cholangitis with autoimmune pancreatitis from primary sclerosing cholangitisGastrointest Endosc6093744PubMedCrossRefGoogle Scholar
  26. 26.
    Kawabe, K, Ito, T, Arita, Y, Nakamuta, M, Takayanagi, T 2006Successful treatment of advanced stage autoimmune pancreatitis-related sclerosing cholangitisPancreas334347PubMedCrossRefGoogle Scholar
  27. 27.
    Okazaki, K, Kawa, S, Kamisawa, T, Naruse, T, Tanaka, S, Nishimori, I,  et al. 2006Clinical diagnostic criteria of autoimmune pancreatitis: revised proposalJ Gastroenterol4162631PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2007

Authors and Affiliations

  • Tetsuhide Ito
    • 1
  • Isao Nishimori
    • 2
  • Naoko Inoue
    • 1
  • Ken Kawabe
    • 1
  • Junya Gibo
    • 1
  • Yoshiyuki Arita
    • 1
  • Kazuichi Okazaki
    • 3
  • Ryoichi Takayanagi
    • 1
  • Makoto Otsuki
    • 4
  1. 1.Department of Medicine and Bioregulatory ScienceGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
  2. 2.Department of Gastroenterology and HepatologyKochi Medical SchoolKochiJapan
  3. 3.Third Department of Internal MedicineKansai Medical UniversityKansaiJapan
  4. 4.Department of Gastroenterology and MetabolismUniversity of Occupational and Environmental Health, Japan, School of MedicineJapan

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