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Journal of Gastroenterology

, Volume 47, Issue 5, pp 553–560 | Cite as

Risk factors for pancreatic stone formation in autoimmune pancreatitis over a long-term course

  • Masahiro Maruyama
  • Norikazu Arakura
  • Yayoi Ozaki
  • Takayuki Watanabe
  • Tetsuya Ito
  • Suguru Yoneda
  • Masafumi Maruyama
  • Takashi Muraki
  • Hideaki Hamano
  • Akihiro Matsumoto
  • Shigeyuki KawaEmail author
Original Article—Liver, Pancreas, and Biliary Tract

Abstract

Background

Autoimmune pancreatitis (AIP) has the potential to progress to a chronic state that forms pancreatic stones. The aim of this study was to clarify the risk factors underlying pancreatic stone formation in AIP.

Methods

Sixty-nine patients with AIP who had been followed for at least 3 years were enrolled for evaluation of clinical and laboratory factors as well as computed tomography and endoscopic retrograde cholangiopancreatography findings.

Results

During the course of this study, increased or de novo stone formation was seen in 28 patients, who were defined as the stone-forming group. No stones were observed in 32 patients, who were defined as the non-stone-forming group. Nine patients who had stones at diagnosis but showed no change during the course of this study were excluded from our cohort. Univariate analysis revealed no significant differences in clinical or laboratory factors associated with AIP-specific inflammation between the two groups. However, pancreatic head swelling (P = 0.006) and narrowing of both Wirsung’s and Santorini’s ducts in the pancreatic head region (P = 0.010) were significantly more frequent in the stone-forming group. Furthermore, multivariate analysis identified Wirsung and Santorini duct narrowing at diagnosis as a significant independent risk factor for pancreatic stone formation (OR 4.4, P = 0.019).

Conclusions

A primary risk factor for pancreatic stone formation in AIP was narrowing of both Wirsung’s and Santorini’s ducts, which most presumably led to pancreatic juice stasis and stone development.

Keywords

Autoimmune pancreatitis Pancreatic stone Wirsung duct Santorini duct 

Abbreviations

AIP

Autoimmune pancreatitis

CT

Computed tomography

ERCP

Endoscopic retrograde cholangiopancreatography

Notes

Acknowledgments

This work was supported partially by the Research Program of Intractable Disease provided by the Ministry of Health, Labor, and Welfare of Japan, and in part by Grants-in-aid for Scientific Research from the Ministry of Education, Science, Sports, and Culture of Japan (23591012). We thank Trevor Ralph for his English editorial assistance.

Conflict of interest

None of the authors have any conflicts of interest associated with this study.

References

  1. 1.
    Kawa S, Hamano H, Kiyosawa K. The autoimmune diseases. In: Rose N, MacKay I, editors. Pancreatitis. 4th ed. St Louis: Academic; 2006.Google Scholar
  2. 2.
    Hamano H, Kawa S, Horiuchi A, Unno H, Furuya N, Akamatsu T, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med. 2001;344:732–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Hamano H, Kawa S, Ochi Y, Unno H, Shiba N, Wajiki M, et al. Hydronephrosis associated with retroperitoneal fibrosis and sclerosing pancreatitis. Lancet. 2002;359:1403–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Yoshida K, Toki F, Takeuchi T, Watanabe S, Shiratori K, Hayashi N. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci. 1995;40:1561–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Takayama M, Hamano H, Ochi Y, Saegusa H, Komatsu K, Muraki T, et al. Recurrent attacks of autoimmune pancreatitis result in pancreatic stone formation. Am J Gastroenterol. 2004;99:932–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Kawa S, Hamano H, Ozaki Y, Ito T, Kodama R, Chou Y, et al. Long-term follow-up of autoimmune pancreatitis: characteristics of chronic disease and recurrence. Clin Gastroenterol Hepatol. 2009;7:S18–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Takuma K, Kamisawa T, Tabata T, Inaba Y, Egawa N, Igarashi Y. Short-term and long-term outcomes of autoimmune pancreatitis. Eur J Gastroenterol Hepatol. 2011;23:146–52.PubMedCrossRefGoogle Scholar
  8. 8.
    Suzuki K, Itoh S, Nagasaka T, Ogawa H, Ota T, Naganawa S. CT findings in autoimmune pancreatitis: assessment using multiphase contrast-enhanced multisection CT. Clin Radiol. 2010;65:735–43.PubMedCrossRefGoogle Scholar
  9. 9.
    Sah RP, Pannala R, Chari ST, Sugumar A, Clain JE, Levy MJ, et al. Prevalence, diagnosis, and profile of autoimmune pancreatitis presenting with features of acute or chronic pancreatitis. Clin Gastroenterol Hepatol. 2010;8:91–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Takada H, Nakazawa T, Ohara H, Ando T, Hayashi K, Naito I, et al. Role of osteopontin in calcification in autoimmune pancreatitis. Dig Dis Sci. 2009;54:793–801.PubMedCrossRefGoogle Scholar
  11. 11.
    Nakazawa T, Ohara H, Sano H, Ando T, Imai H, Takada H, et al. Difficulty in diagnosing autoimmune pancreatitis by imaging findings. Gastrointest Endosc. 2007;65:99–108.PubMedCrossRefGoogle Scholar
  12. 12.
    Nishino T, Toki F, Oyama H, Shimizu K, Shiratori K. Long-term outcome of autoimmune pancreatitis after oral prednisolone therapy. Intern Med. 2006;45:497–501.PubMedCrossRefGoogle Scholar
  13. 13.
    Takayama T. Pathophysiological study of experimental pancreatolithiasis in the dog. Jpn J Gastroenterol. 1979;76:1325–36. (in Japanese with English abstract).Google Scholar
  14. 14.
    Konishi K, Izumi R, Kato O, Yamaguchi A, Miyazaki I. Experimental pancreatolithiasis in the dog. Surgery. 1981;89:687–91.PubMedGoogle Scholar
  15. 15.
    Wakabayashi T, Kawaura Y, Satomura Y, Watanabe H, Motoo Y, Sawabu N. Long-term prognosis of duct-narrowing chronic pancreatitis: strategy for steroid treatment. Pancreas. 2005;30:31–9.PubMedGoogle Scholar
  16. 16.
    Horiuchi A, Kawa S, Hamano H, Hayama M, Ota H, Kiyosawa K. ERCP features in 27 patients with autoimmune pancreatitis. Gastrointest Endosc. 2002;55:494–9.PubMedGoogle Scholar
  17. 17.
    Otsuki M, Chung JB, Okazaki K, Kim MH, Kamisawa T, Kawa S, et al. Asian diagnostic criteria for autoimmune pancreatitis: consensus of the Japan–Korea symposium on autoimmune pancreatitis. J Gastroenterol. 2008;43:403–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Haaga JR, Alfidi RJ, Zelch MG, Meany TF, Boller M, Gonzalez L, et al. Computed tomography of the pancreas. Radiology. 1976;120:589–95.PubMedGoogle Scholar
  19. 19.
    Muraki T, Hamano H, Ochi Y, Komatsu K, Komiyama Y, Arakura N, et al. Autoimmune pancreatitis and complement activation system. Pancreas. 2006;32:16–21.PubMedCrossRefGoogle Scholar
  20. 20.
    Kawa S, Hamano H, Kiyosawa K. High serum IgG4 concentrations in patients with sclerosing pancreatitis. Reply. N Engl J Med. 2001;345:147–8.Google Scholar
  21. 21.
    Song MH, Kim MH, Lee SK, Seo DW, Lee SS, Han J, et al. Regression of pancreatic fibrosis after steroid therapy in patients with autoimmune chronic pancreatitis. Pancreas. 2005;30:83–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Ko SB, Mizuno N, Yatabe Y, Yoshikawa T, Ishiguro H, Yamamoto A, et al. Corticosteroids correct aberrant CFTR localization in the duct and regenerate acinar cells in autoimmune pancreatitis. Gastroenterology. 2010;138:1988–96.PubMedCrossRefGoogle Scholar
  23. 23.
    Stevens T, Conwell DL, Zuccaro G. Pathogenesis of chronic pancreatitis: an evidence-based review of past theories and recent developments. Am J Gastroenterol. 2004;99:2256–70.PubMedCrossRefGoogle Scholar
  24. 24.
    Braganza JM, Lee SH, McCloy RF, McMahon MJ. Chronic pancreatitis. Lancet. 2011;377:1184–97.PubMedCrossRefGoogle Scholar
  25. 25.
    Sarles H. Etiopathogenesis and definition of chronic pancreatitis. Dig Dis Sci. 1986;31:91S–107S.PubMedCrossRefGoogle Scholar
  26. 26.
    Suda K, Takase M, Takei K, Kumasaka T, Suzuki F. Histopathologic and immunohistochemical studies on the mechanism of interlobular fibrosis of the pancreas. Arch Pathol Lab Med. 2000;124:1302–5.PubMedGoogle Scholar
  27. 27.
    Origuchi N, Kimura W, Muto T, Esaki Y. Pancreatic mucin-producing adenocarcinoma associated with a pancreatic stone: report of a case. Surg Today. 1998;28:1261–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2011

Authors and Affiliations

  • Masahiro Maruyama
    • 1
  • Norikazu Arakura
    • 2
  • Yayoi Ozaki
    • 1
  • Takayuki Watanabe
    • 1
  • Tetsuya Ito
    • 1
  • Suguru Yoneda
    • 1
  • Masafumi Maruyama
    • 1
  • Takashi Muraki
    • 1
  • Hideaki Hamano
    • 1
  • Akihiro Matsumoto
    • 1
  • Shigeyuki Kawa
    • 3
    Email author
  1. 1.Department of GastroenterologyShinshu University School of MedicineMatsumotoJapan
  2. 2.Endoscopic Examination CenterShinshu University School of MedicineMatsumotoJapan
  3. 3.Center for Health, Safety, and Environmental ManagementShinshu UniversityMatsumotoJapan

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