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Comparison of steroid pulse therapy and conventional oral steroid therapy as initial treatment for autoimmune pancreatitis

Journal of Gastroenterology volume 46, pages 696–704 (2011)Cite this article

Abstract

Background

The efficacy of oral steroid therapy for autoimmune pancreatitis (AIP) is well known, and oral prednisolone treatment is most usually commenced at 30–40 mg/day, but there have been few reports about comparative studies of oral steroid therapy and steroid pulse therapy as the initial treatment for AIP. We studied the clinical course and image findings to estimate the utility of steroid pulse therapy for AIP, comparing it with oral steroid therapy.

Methods

Laboratory and image findings were assessed retrospectively in 11 patients who received steroid pulse therapy, and the findings were compared to those in 10 patients who received conventional oral steroid therapy.

Results

Change in pancreatic size showed no significant difference between the therapies after 2 weeks of treatment. Significant improvement of lower bile duct strictures after 2 weeks of treatment and that of immunoglobulin values within 6 months were shown with both therapies. However, steroid pulse therapy showed significant improvement of γ-guanosine triphosphate (GTP) in 2 weeks and of alanine aminotransferase (ALT) in 2 and 8 weeks, compared with oral steroid therapy. Moreover, there was one patient in whom the lower bile duct stricture was not improved by oral steroid therapy, but it did show improvement with steroid pulse therapy.

Conclusions

Initial steroid pulse therapy is a beneficial alternative to oral steroid therapy for the improvement of bile duct lesions. In future, the accumulation of a larger number of patients receiving steroid pulse therapy is needed, and prospective studies will be required.

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Acknowledgments

This study was partially supported by: (1) a Grant-in-Aid for Scientific Research (C) of the Ministry of Culture and Science of Japan (20590810); (2) Health and Labor Sciences Research Grants (K.O.) for Intractable Diseases, from the Minister of Labor and Welfare of Japan; and (3) grants-in-aid from CREST Japan Science and Technology Agency.

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Affiliations

  1. Division of Gastroenterology and Hepatology, the Third Department of Internal Medicine, Kansai Medical University, 10-15 Fumizono, Moriguchi, Osaka, 570-8507, Japan

    Takashi Tomiyama, Kazushige Uchida, Mitsunobu Matsushita, Tsukasa Ikeura, Toshiro Fukui, Makoto Takaoka, Akiyoshi Nishio & Kazuichi Okazaki

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  1. Takashi Tomiyama
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  2. Kazushige Uchida
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  3. Mitsunobu Matsushita
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  4. Tsukasa Ikeura
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  5. Toshiro Fukui
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  6. Makoto Takaoka
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  7. Akiyoshi Nishio
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  8. Kazuichi Okazaki
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Correspondence to Kazuichi Okazaki.

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Tomiyama, T., Uchida, K., Matsushita, M. et al. Comparison of steroid pulse therapy and conventional oral steroid therapy as initial treatment for autoimmune pancreatitis. J Gastroenterol 46, 696–704 (2011). https://doi.org/10.1007/s00535-010-0361-y

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  • DOI: https://doi.org/10.1007/s00535-010-0361-y

Keywords

  • Autoimmune pancreatitis (AIP)
  • Steroid pulse therapy
  • Bile duct stricture
  • Diabetes mellitus
  • Pancreatic cancer