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Review of diagnostic criteria for autoimmune pancreatitis; for establishment of international criteria

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Abstract

Along with worldwide expansion of the disease concept of autoimmune pancreatitis (AIP), the necessity of international diagnostic criteria for the disease is increasing. Since the first diagnostic criteria for AIP by the Japan Pancreas Society was proposed in 2002, certain groups in several countries have reported criteria for AIP. We reviewed the criteria proposed to date. Among three systematic criteria from Japan, the Mayo Clinic and Korea, there is no fundamental difference in the three major diagnostic categories: findings on pancreatic imaging, laboratory and histological studies. Notable differences are that typical imaging findings are essential for the diagnosis in Japanese and Korean criteria, but not in the Mayo criteria, while, the Mayo criteria emphasize the histological findings as a gold standard for the diagnosis. The critical differences between the Japanese and the other two criteria are the use of the diagnostic factors “other organ involvement” and “steroid responsiveness.” Employment of these factors in clinical diagnostic criteria for general physicians possibly confuses the disease concept and definitely increases the risk for treating patients with pancreatic or biliary malignancies with steroids. Even if the sensitivity of criteria goes down, their use might be limited to certain kinds of specific criteria, such as that for epidemiological study, patient selection for research purposes, or use in expert hospitals. The disease entity of AIP postulated in Europe includes two histological types of pancreatitis with different clinical phenotypes, suggesting two syndromic spectra of autoimmune-related chronic pancreatitis.

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References

  1. Sarles H, Sarles JC, Muratore R, Guien C. Chronic inflammatory sclerosis of the pancreas—an autonomous pancreatic disease? Am J Dig Dis. 1961;6:688–98.

    Article  PubMed  CAS  Google Scholar 

  2. Nakano E, Takeda I, Kitamura K, Watahiki H, Iimura Y, Takenaka M. Vanishing tumor of the abdomen of in patients with Sjögren’s syndrome. Am J Dig Dis. 1978;23(Suppl):75S–9S.

    Article  Google Scholar 

  3. Bank S, Novis BH, Petersen E, Dowdle E, Marks IN. Serum immunoglobulins in calcific pancreatitis. Gut. 1973;14:723–5.

    Article  PubMed  CAS  Google Scholar 

  4. Antal L, Kavai M, Szabo G, Sonkoly I, Paloczi K, Szegedi G, et al. Immunological investigations in acute and chronic human pancreatitis. Digestion. 1980;20:100–5.

    PubMed  CAS  Google Scholar 

  5. Lankisch PG, Koop H, Seelig R, Seelig HP. Antinuclear and pancreatic acinar cell antibodies in pancreatic diseases. Digestion. 1981;21:65–8.

    Article  PubMed  CAS  Google Scholar 

  6. Bovo P, Mirakian R, Merigo F, Angelini G, Cavallini G, Rizzini P, et al. HLA molecule expression on chronic pancreatitis specimens: Is there a role for autoimmunity? A preliminary study. Pancreas. 1987;2:350–6.

    Article  PubMed  CAS  Google Scholar 

  7. Toki F, Kozu T, Oi I, Nakasato T, Suzuki M, Hanyu F. An unusual type of chronic pancreatitis showing diffuse irregular narrowing of the entire main pancreatic duct on ERCP: a report of four cases (abstract). Endoscopy. 1992;24:640.

    Google Scholar 

  8. 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.

    Article  PubMed  CAS  Google Scholar 

  9. Ito T, Nakano I, Koyanagi S, Miyahara T, Migita Y, Ogoshi K, et al. Autoimmune pancreatitis as a new clinical entity. Three cases of autoimmune pancreatitis with effective steroid therapy. Dig Dis Sci. 1997;42:1458–68.

    Article  PubMed  CAS  Google Scholar 

  10. Homma T, Harada H, Koizumi M. Diagnostic criteria for chronic pancreatitis by the Japan Pancreas Society. Pancreas. 1997;15:14–5.

    Article  PubMed  CAS  Google Scholar 

  11. Otsuki M. Chronic pancreatitis. The problems of diagnostic criteria. Pancreatology. 2004;4:28–41.

    Article  PubMed  Google Scholar 

  12. Members of the Criteria Committee for Autoimmune Pancreatitis of the Japan Pancreas Society. Diagnostic criteria for autoimmune pancreatitis 2002 by the Japan Pancreas Society (in Japanese with English abstract). Suizo (J Jpn Panc Soc). 2002;17:585–7.

    Google Scholar 

  13. Okazaki K, Kawa S, Kamisawa T, Naruse S, Tanaka S, Nishimori I, et al. Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal. J Gastroenterol. 2006;41:626–31.

    Article  PubMed  Google Scholar 

  14. Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, Zhang L, et al. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol. 2006;4:1010–6.

    Article  PubMed  Google Scholar 

  15. Kawaguchi K, Koike M, Tsuruta K, Okamoto A, Tabata I, Fujita N. Lymphoplasmacytic sclerosing pancreatitis with cholangitis: a variant of primary sclerosing cholangitis extensively involving pancreas. Hum Pathol. 1991;22:387–95.

    Article  PubMed  CAS  Google Scholar 

  16. Weber SM, Cubukcu-Dimopulo O, Palesty JA, Suriawinata A, Klimstra D, Brennan MF, et al. Lymphoplasmacytic sclerosing pancreatitis: inflammatory mimic of pancreatic carcinoma. J Gastrointest Surg. 2003;7:129–37.

    Article  PubMed  Google Scholar 

  17. Finkelberg DL, Sahani D, Deshpande V, Brugge WR. Autoimmune pancreatitis. N Engl J Med. 2006;355:2670–6.

    Article  PubMed  CAS  Google Scholar 

  18. Kim KP, Kim MH, Kim JC, Lee SS, Seo DW, Lee SK. Diagnostic criteria for autoimmune chronic pancreatitis revisited. World J Gastroenterol. 2006;12:2487–96.

    PubMed  Google Scholar 

  19. Ryu JK. Overview of diagnostic criteria for autoimmune pancareatitis. Korean J Panc Bilary Tract. 2007;12:105–12.

    Google Scholar 

  20. Pearson RK, Longnecker DS, Chari ST, Smyrk TC, Okazaki K, Frulloni L, et al. Controversies in clinical pancreatology: autoimmune pancreatitis: does it exist? Pancreas. 2003;27:1–13.

    Article  PubMed  Google Scholar 

  21. Kamisawa T, Okamoto A. Autoimmune pancreatitis: proposal of IgG4-related sclerosing disease. J Gastroenterol. 2006;41:613–25.

    Article  PubMed  CAS  Google Scholar 

  22. Ohara H, Nakazawa T, Sano H, Ando T, Okamoto T, Takada H, et al. Systemic extrapancreatic lesions associated with autoimmune pancreatitis. Pancreas. 2005;31:232–7.

    Article  PubMed  Google Scholar 

  23. Hamano H, Arakura N, Muraki T, Ozaki Y, Kiyosawa K, Kawa S. Prevalence and distribution of extrapancreatic lesions complicating autoimmune pancreatitis. J Gastroenterol. 2006;41:1197–205.

    Article  PubMed  Google Scholar 

  24. Nishimori I, Onishi S, Ostuki M. Nationwide survey for autoimmune pancreatitis in Japan (in Japanese with English abstract). Suizo (J Jpn Panc Soc). 2007;22:657–62.

    Google Scholar 

  25. Aparisi L, Farre A, Gomez-Cambronero L, Martinez J, De Las Heras G, Corts J, et al. Antibodies to carbonic anhydrase and IgG4 levels in idiopathic chronic pancreatitis: relevance for diagnosis of autoimmune pancreatitis. Gut. 2005;54:703–9.

    Article  PubMed  CAS  Google Scholar 

  26. Zamboni G, Lüttges J, Capelli P, Frulloni L, Cavallini G, Pederzoli P, et al. Histopathological features of diagnostic and clinical relevance in autoimmune pancreatitis: a study on 53 resection specimens and 9 biopsy specimens. Virchows Arch. 2004;445:552–63.

    Article  PubMed  Google Scholar 

  27. Notohara K, Burgart LJ, Yadav D, Chari S, Smyrk TC. Idiopathic chronic pancreatitis with periductal lymphoplasmacytic infiltration: clinicopathologic features of 35 cases. Am J Surg Pathol. 2003;27:1119–27.

    Article  PubMed  Google Scholar 

  28. Zhang L, Notohara K, Levy MJ, Chari ST, Smyrk TC. IgG4-positive plasma cell infiltration in the diagnosis of autoimmune pancreatitis. Mod Pathol. 2007;20:23–8.

    Article  PubMed  CAS  Google Scholar 

  29. Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology. 2001;120:682–707.

    Article  PubMed  CAS  Google Scholar 

  30. Yamamoto M, Harada S, Ohara M, Suzuki C, Naishiro Y, Yamamoto H, et al. Clinical and pathological differences between Mikulicz’s disease and Sjögren’s syndrome. Rheumatology (Oxford). 2005;44:227–34.

    Article  CAS  Google Scholar 

  31. Okazaki K, Uchida K, Matsushita M, Takaoka M. How to diagnose autoimmune pancreatitis by the revised Japanese clinical criteria. J Gastroenterol. 2007;42(Suppl 18):32–8.

    Article  PubMed  Google Scholar 

  32. Kawa S, Hamano H. Clinical features of autoimmune pancreatitis. J Gastroenterol. 2007;42(Suppl 18):9–14.

    Article  PubMed  Google Scholar 

  33. Ghazale A, Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, et al. Value of serum IgG4 in the diagnosis of autoimmune pancreatitis and in distinguishing it from pancreatic cancer. Am J Gastroenterol. 2007;102:1646–53.

    Article  PubMed  CAS  Google Scholar 

  34. Hirano K, Kawabe T, Yamamoto N, Nakai Y, Sasahira N, Tsujino T, et al. Serum IgG4 concentrations in pancreatic and biliary diseases. Clin Chim Acta. 2006;367:181–4.

    Article  PubMed  CAS  Google Scholar 

  35. Mendes FD, Jorgensen R, Keach J, Katzmann JA, Smyrk T, Donlinger J, et al. Elevated serum IgG4 concentration in patients with primary sclerosing cholangitis. Am J Gastroenterol. 2006;101:2070–5.

    Article  PubMed  CAS  Google Scholar 

  36. Levy MJ, Reddy RP, Wiersema MJ, Smyrk TC, Clain JE, Harewood GC, et al. EUS-guided trucut biopsy in establishing autoimmune pancreatitis as the cause of obstructive jaundice. Gastrointest Endosc. 2005;61:467–72.

    Article  PubMed  Google Scholar 

  37. Levy MJ. Endoscopic ultrasound-guided trucut biopsy of the pancreas: prospects and problems. Pancreatology. 2007;7:163–6.

    Article  PubMed  Google Scholar 

  38. Kamisawa T, Chen PY, Tu Y, Nakajima H, Egawa N, Tsuruta K, et al. Pancreatic cancer with a high serum IgG4 concentration. World J Gastroenterol. 2006;12:6225–8.

    PubMed  CAS  Google Scholar 

  39. Inoue H, Miyatani H, Sawada Y, Yoshida Y. A case of pancreas cancer with autoimmune pancreatitis. Pancreas. 2006;33:208–9.

    Article  PubMed  Google Scholar 

  40. Taniguchi T, Hamasaki A, Okamoto M. A case of suspected lymphocytic hypophysitis and organizing pneumonia during maintenance therapy for autoimmune pancreatitis associated with autoimmune thrombocytopenia. Endocr J. 2006;53:563–6.

    Article  PubMed  Google Scholar 

  41. Yoshimura Y, Takeda S, Ieki Y, Takazakura E, Koizumi H, Takagawa K. IgG4-associated prostatitis complicating autoimmune pancreatitis. Intern Med. 2006;45:897–901.

    Article  PubMed  Google Scholar 

  42. Nishimori I, Kohsaki T, Onishi S, Shuin T, Kohsaki S, Ogawa Y, et al. IgG4-related autoimmune prostatitis: two cases with or without autoimmune pancreatitis. Intern Med. 2007;46:1983–9.

    Article  PubMed  Google Scholar 

  43. Chari ST. Current concepts in the treatment of autoimmune pancreatitis. JOP. 2007;8:1–3.

    PubMed  Google Scholar 

  44. Kim MH, Kwon S. Diagnostic criteria for autoimmune chronic pancreatitis. J Gastroenterol. 2007;42(Suppl 18):42–9.

    Article  PubMed  Google Scholar 

  45. Ito T, Nishimori I, Inoue N, Kawabe K, Gibo J, Arita Y, et al. Treatment for autoimmune pancreatitis: consensus on the treatment for patients with autoimmune pancreatitis in Japan. J Gastroenterol. 2007;42(Suppl 18):50–8.

    Article  PubMed  Google Scholar 

  46. Knezevic D. Suppression of tumor immunity by electromagnetic fields and glucocorticoids in mice with implanted Ehrlich carcinoma. Med Pregl. 2005;58:609–13.

    PubMed  Google Scholar 

  47. Ohtsubo K, Watanabe H, Okada G, Tsuchiyama T, Mouri H, Yamaguchi Y, et al. A case of pancreatic cancer with formation of a mass mimicking alcoholic or autoimmune pancreatitis in a young man. Possibility of diagnosis by hypermethylation of pure pancreatic juice. JOP. 2008;9:37–45.

    PubMed  Google Scholar 

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Acknowledgment

This work was supported by the Health and Labour Sciences Research Grant for Intractable Pancreatic Diseases.

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Authors and Affiliations

  1. Department of Endoscopy, Kochi Medical School, Nankoku, 783-8505, Japan

    Isao Nishimori

  2. Department of Gastroenterology and Hepatology, Kochi Medical School, Nankoku, Japan

    Saburo Onishi

  3. Department of Gastroenterology and Metabolism, University of Occupational and Environmental Health, Japan, School of Medicine, Kitakyushu, Japan

    Makoto Otsuki

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  1. Isao Nishimori
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  2. Saburo Onishi
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Correspondence to Isao Nishimori.

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Nishimori, I., Onishi, S. & Otsuki, M. Review of diagnostic criteria for autoimmune pancreatitis; for establishment of international criteria. Clin J Gastroenterol 1, 7–17 (2008). https://doi.org/10.1007/s12328-008-0002-7

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  • DOI: https://doi.org/10.1007/s12328-008-0002-7

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