Summary and Look to the Future
Autoimmune pancreatitis (AIP) is a rare immunological disorder that requires a high degree of expertise from gastroenterologists, pathologists, and radiologists – as provided in this book. The diagnosis has traditionally been based on pancreatic imaging, principally ERCP and CT scans, but recent advances in endoscopic ultrasound (EUS) and MRI have provided improved accuracy. Biopsies of the pancreas, guided by EUS, have made it possible to provide a tissue diagnosis. In addition, ampullary and duodenal biopsies can provide tissue evidence of IgG4 plasma cell infiltration of the upper gastrointestinal tract. While international consensus definitions allow to distinguish between type 1 AIP (lymphoplasmacytic sclerosing pancreatitis) and type 2 AIP (idiopathic duct-centric pancreatitis), their underlying pathophysiology remains largely obscure. Future research will aim at a refinement of diagnostic tests, specifically for type 2 AIP where IgG4 is not elevated and for monitoring therapy. It will also have to identify parameters for recurrence, define the appropriate treatment intervals for long-term immunosuppression, and establish alternatives to corticosteroid treatment. We hope that enthusiasm to invest in clinical research on AIP shall not fade and patients with other varieties of pancreatitis may benefit from its progress as well.
KeywordsPancreatic Cancer Chronic Pancreatitis Primary Sclerosing Cholangitis Endoscopic Ultrasound Mycophenolate Mofetil
Some of the points discussed here have recently been reviewed in a commentary in the journal Gut (2011 May;60(5):565–6). The authors thank Julia Mayerle for helpful discussions.
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