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

  • Makoto Otsuki
  • Jae Bock Chung
  • Kazuichi Okazaki
  • Myung-Hwan Kim
  • Terumi Kamisawa
  • Shigeyuki Kawa
  • Seung Woo Park
  • Tooru Shimosegawa
  • Kyutaek Lee
  • Tetsuhide Ito
  • Isao Nishimori
  • Kenji Notohara
  • Satoru Naruse
  • Shigeru B. H. Ko
  • Yasuyuki Kihara
  • 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
Special Article

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 

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Copyright information

© Springer Japan 2008

Authors and Affiliations

  • Makoto Otsuki
    • 1
  • Jae Bock Chung
    • 2
  • Kazuichi Okazaki
    • 3
  • Myung-Hwan Kim
    • 4
  • Terumi Kamisawa
    • 5
  • Shigeyuki Kawa
    • 6
  • Seung Woo Park
    • 2
  • Tooru Shimosegawa
    • 7
  • Kyutaek Lee
    • 8
  • Tetsuhide Ito
    • 9
  • Isao Nishimori
    • 10
  • Kenji Notohara
    • 11
  • Satoru Naruse
    • 12
  • Shigeru B. H. Ko
    • 12
  • Yasuyuki Kihara
    • 1
  • 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
  1. 1.Department of Gastroenterology and MetabolismUniversity of Occupational and Environmental Health, Japan, School of MedicineKitakyushuJapan
  2. 2.Department of Internal Medicine, Division of GastroenterologyYonsei University College of MedicineSeoulKorea
  3. 3.The Third Department of Internal MedicineKansai Medical UniversityOsakaJapan
  4. 4.Department of GastroenterologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea
  5. 5.Department of Internal MedicineTokyo Metropolitan Komagome HospitalTokyoJapan
  6. 6.Center for Health, Safety and Environmental ManagementShinshu UniversityMatsumotoJapan
  7. 7.Department of GastroenterologyTohoku University, Graduate School of MedicineSendaiJapan
  8. 8.Department of Medicine, School of MedicineSungkyunkwan University, Samsung Medical CenterSeoulKorea
  9. 9.Department of Medicine and Bioregulatory Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  10. 10.Department of Gastroenterology and HepatologyKochi Medical SchoolNankokuJapan
  11. 11.Department of PathologyKurashiki Central HospitalKurashikiJapan
  12. 12.Department of GastroenterologyNagoya University, Graduate School of MedicineNagoyaJapan

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