Long-term outcomes of autoimmune pancreatitis: a multicentre, international analysis

被引:428
作者
Hart, Phil A. [1 ]
Kamisawa, Terumi [2 ]
Brugge, William R. [3 ]
Chung, Jae Bock [4 ]
Culver, Emma L. [5 ]
Czako, Laszlo [6 ]
Frulloni, Luca [7 ]
Go, Vay Liang W. [8 ]
Gress, Thomas M. [9 ]
Kim, Myung-Hwan [10 ]
Kawa, Shigeyuki [11 ]
Lee, Kyu Taek [12 ]
Lerch, Markus M. [13 ]
Liao, Wei-Chih [14 ]
Lohr, Matthias [15 ,16 ]
Okazaki, Kazuichi [17 ]
Ryu, Ji Kon [18 ]
Schleinitz, Nicolas [19 ]
Shimizu, Kyoko [20 ]
Shimosegawa, Tooru [21 ]
Soetikno, Roy [22 ]
Webster, George [23 ]
Yadav, Dhiraj [24 ]
Zen, Yoh [25 ]
Chari, Suresh T. [1 ]
机构
[1] Mayo Clin, Div Gastroenterol & Hepatol, Rochester, MN USA
[2] Tokyo Metropolitan Komagome Hosp, Dept Internal Med, Tokyo 1138677, Japan
[3] Massachusetts Gen Hosp, GI Unit, Dept Internal Med, Boston, MA 02114 USA
[4] Yonsei Univ, Coll Med, Dept Internal Med, Inst Gastroenterol,Severance Hosp, Seoul, South Korea
[5] John Radcliffe Hosp, Translat Gastroenterol Unit, Oxford OX3 9DU, England
[6] Univ Szeged, Dept Internal Med 1, Szeged, Hungary
[7] Univ Verona, Dept Med Biomed & Surg Sci, I-37100 Verona, Italy
[8] Univ Calif Los Angeles, David Geffen Sch Med, Ctr Excellence Pancreat Dis, Los Angeles, CA 90095 USA
[9] Univ Marburg, Dept Gastroenterol Endocrinol Metab & Infectiol, Marburg, Germany
[10] Univ Ulsan, Coll Med, Dept Internal Med, Asan Med Ctr, Seoul, South Korea
[11] Shinshu Univ, Ctr Hlth Safety & Environm Management, Matsumoto, Nagano 390, Japan
[12] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Dept Med, Seoul, South Korea
[13] Univ Med Greifswald, Dept Med A, Greifswald, Germany
[14] Natl Taiwan Univ Hosp, Dept Internal Med, Taipei 100, Taiwan
[15] Karolinska Inst, Dept Surg Gastroenterol, Stockholm, Sweden
[16] Karolinska Univ Hosp, Stockholm, Sweden
[17] Kansai Med Univ, Dept Gastroenterol & Hepatol, Osaka, Japan
[18] Seoul Natl Univ, Coll Med, Dept Internal Med, Seoul 151, South Korea
[19] Aix Marseille Univ, Dept Internal Med, Marseille, France
[20] Tokyo Womens Med Univ, Sch Med, Dept Gastroenterol, Tokyo, Japan
[21] Tohoku Univ, Div Gastroenterol, Grad Sch Med, Sendai, Miyagi 980, Japan
[22] Affiliated Stanford Univ, Dept Internal Med, Palo Alto, CA USA
[23] Univ Coll London Hosp, Dept Gastroenterol, London, England
[24] Univ Pittsburgh, Div Gastroenterol Hepatol & Nutr, Pittsburgh, PA 15260 USA
[25] Kings Coll Hosp London, Inst Liver Studies, London, England
关键词
Autoimmune Disease; Pancreatic Cancer; Pancreato-Biliary Disorders; CLINICAL PROFILE; FEATURES;
D O I
10.1136/gutjnl-2012-303617
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objective Autoimmune pancreatitis (AIP) is a treatable form of chronic pancreatitis that has been increasingly recognised over the last decade. We set out to better understand the current burden of AIP at several academic institutions diagnosed using the International Consensus Diagnostic Criteria, and to describe long-term outcomes, including organs involved, treatments, relapse frequency and long-term sequelae. Design 23 institutions from 10 different countries participated in this multinational analysis. A total of 1064 patients meeting the International Consensus Diagnostic Criteria for type 1 (n=978) or type 2 (n=86) AIP were included. Data regarding treatments, relapses and sequelae were obtained. Results The majority of patients with type 1 (99%) and type 2 (92%) AIP who were treated with steroids went into clinical remission. Most patients with jaundice required biliary stent placement (71% of type 1 and 77% of type 2 AIP). Relapses were more common in patients with type 1 (31%) versus type 2 AIP (9%, p<0.001), especially those with IgG4-related sclerosing cholangitis (56% vs 26%, p<0.001). Relapses typically occurred in the pancreas or biliary tree. Retreatment with steroids remained effective at inducing remission with or without alternative treatment, such as azathioprine. Pancreatic duct stones and cancer were uncommon sequelae in type 1 AIP and did not occur in type 2 AIP during the study period. Conclusions AIP is a global disease which uniformly displays a high response to steroid treatment and tendency to relapse in the pancreas and biliary tree. Potential long-term sequelae include pancreatic duct stones and malignancy, however they were uncommon during the study period and require additional follow-up. Additional studies investigating prevention and treatment of disease relapses are needed.
引用
收藏
页码:1771 / 1776
页数:6
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