Autoimmune pancreatitis classification: Difference between revisions
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{{Autoimmune pancreatitis}} | {{Autoimmune pancreatitis}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}}{{IQ}} | ||
==Overview== | ==Overview== | ||
Autoimmune pancreatitis may be classified into two types; type 1 AIP and type 2 AIP or idiopathic duct-centric pancreatitis. Type 1 AIP meets the HISORt criteria, involves [[pancreas]] as one part of a [[systemic]] IgG4-positive disease. Type 2 consists of granulocytic lesions, does not involve IgG4-positive cells, has no systemic involvement, and is usually associated with [[inflammatory bowel disease]]. | |||
==Classification== | ==Classification== | ||
*Autoimmune pancreatitis may be classified into two types | *Autoimmune pancreatitis can be:<ref name="pmid15017645">{{cite journal |vauthors=Hirano K, Shiratori Y, Komatsu Y, Yamamoto N, Sasahira N, Toda N, Isayama H, Tada M, Tsujino T, Nakata R, Kawase T, Katamoto T, Kawabe T, Omata M |title=Involvement of the biliary system in autoimmune pancreatitis: a follow-up study |journal=Clin. Gastroenterol. Hepatol. |volume=1 |issue=6 |pages=453–64 |year=2003 |pmid=15017645 |doi= |url=}}</ref><ref name="pmid18222442">{{cite journal |vauthors=Ghazale A, Chari ST, Zhang L, Smyrk TC, Takahashi N, Levy MJ, Topazian MD, Clain JE, Pearson RK, Petersen BT, Vege SS, Lindor K, Farnell MB |title=Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy |journal=Gastroenterology |volume=134 |issue=3 |pages=706–15 |year=2008 |pmid=18222442 |doi=10.1053/j.gastro.2007.12.009 |url=}}</ref><ref name="pmid19532132">{{cite journal |vauthors=Raina A, Yadav D, Krasinskas AM, McGrath KM, Khalid A, Sanders M, Whitcomb DC, Slivka A |title=Evaluation and management of autoimmune pancreatitis: experience at a large US center |journal=Am. J. Gastroenterol. |volume=104 |issue=9 |pages=2295–306 |year=2009 |pmid=19532132 |doi=10.1038/ajg.2009.325 |url=}}</ref><ref name="pmid12769204">{{cite journal |vauthors=Tabata M, Kitayama J, Kanemoto H, Fukasawa T, Goto H, Taniwaka K |title=Autoimmune pancreatitis presenting as a mass in the head of the pancreas: a diagnosis to differentiate from cancer |journal=Am Surg |volume=69 |issue=5 |pages=363–6 |year=2003 |pmid=12769204 |doi= |url=}}</ref><ref name="pmid10406367">{{cite journal |vauthors=Erkelens GW, Vleggaar FP, Lesterhuis W, van Buuren HR, van der Werf SD |title=Sclerosing pancreato-cholangitis responsive to steroid therapy |journal=Lancet |volume=354 |issue=9172 |pages=43–4 |year=1999 |pmid=10406367 |doi= |url=}}</ref><ref name="pmid12856677">{{cite journal |vauthors=Kojima E, Kimura K, Noda Y, Kobayashi G, Itoh K, Fujita N |title=Autoimmune pancreatitis and multiple bile duct strictures treated effectively with steroid |journal=J. Gastroenterol. |volume=38 |issue=6 |pages=603–7 |year=2003 |pmid=12856677 |doi= |url=}}</ref><ref name="pmid8946997">{{cite journal |vauthors=Horiuchi A, Kaneko T, Yamamura N, Nagata A, Nakamura T, Akamatsu T, Mukawa K, Kawa S, Kiyosawa K |title=Autoimmune chronic pancreatitis simulating pancreatic lymphoma |journal=Am. J. Gastroenterol. |volume=91 |issue=12 |pages=2607–9 |year=1996 |pmid=8946997 |doi= |url=}}</ref><ref name="pmid15990840">{{cite journal |vauthors=Hamano H, Kawa S, Uehara T, Ochi Y, Takayama M, Komatsu K, Muraki T, Umino J, Kiyosawa K, Miyagawa S |title=Immunoglobulin G4-related lymphoplasmacytic sclerosing cholangitis that mimics infiltrating hilar cholangiocarcinoma: part of a spectrum of autoimmune pancreatitis? |journal=Gastrointest. Endosc. |volume=62 |issue=1 |pages=152–7 |year=2005 |pmid=15990840 |doi= |url=}}</ref><ref name="pmid17894845">{{cite journal |vauthors=Church NI, Pereira SP, Deheragoda MG, Sandanayake N, Amin Z, Lees WR, Gillams A, Rodriguez-Justo M, Novelli M, Seward EW, Hatfield AR, Webster GJ |title=Autoimmune pancreatitis: clinical and radiological features and objective response to steroid therapy in a UK series |journal=Am. J. Gastroenterol. |volume=102 |issue=11 |pages=2417–25 |year=2007 |pmid=17894845 |doi=10.1111/j.1572-0241.2007.01531.x |url=}}</ref> | ||
**Type 1 AIP | **Primary (when main pathology is in [[pancreas]]) or, | ||
**Type 2 AIP or idiopathic duct-centric pancreatitis | **Secondary (when associated with other [[systemic]] autoimmune diseases such as IgG4-associated [[cholangitis]], chronic sclerosing sialadenitis, [[tubulointerstitial nephritis]], and [[ulcerative colitis]]). | ||
*Autoimmune pancreatitis may be classified into two types: | |||
**Type 1 AIP. | |||
**Type 2 AIP or idiopathic duct-centric [[pancreatitis]]. | |||
=== Type 1 AIP: === | === Type 1 AIP: === | ||
* Type 1 AIP meets the HISORt criteria.<ref name="pmid19410017">{{cite journal |vauthors=Chari ST, Takahashi N, Levy MJ, Smyrk TC, Clain JE, Pearson RK, Petersen BT, Topazian MA, Vege SS |title=A diagnostic strategy to distinguish autoimmune pancreatitis from pancreatic cancer |journal=Clin. Gastroenterol. Hepatol. |volume=7 |issue=10 |pages=1097–103 |year=2009 |pmid=19410017 |doi=10.1016/j.cgh.2009.04.020 |url=}}</ref><ref name="pmid16843735">{{cite journal |vauthors=Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, Zhang L, Clain JE, Pearson RK, Petersen BT, Vege SS, Farnell MB |title=Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience |journal=Clin. Gastroenterol. Hepatol. |volume=4 |issue=8 |pages=1010–6; quiz 934 |year=2006 |pmid=16843735 |doi=10.1016/j.cgh.2006.05.017 |url=}}</ref> | * Type 1 AIP meets the HISORt criteria.<ref name="pmid19410017">{{cite journal |vauthors=Chari ST, Takahashi N, Levy MJ, Smyrk TC, Clain JE, Pearson RK, Petersen BT, Topazian MA, Vege SS |title=A diagnostic strategy to distinguish autoimmune pancreatitis from pancreatic cancer |journal=Clin. Gastroenterol. Hepatol. |volume=7 |issue=10 |pages=1097–103 |year=2009 |pmid=19410017 |doi=10.1016/j.cgh.2009.04.020 |url=}}</ref><ref name="pmid16843735">{{cite journal |vauthors=Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, Zhang L, Clain JE, Pearson RK, Petersen BT, Vege SS, Farnell MB |title=Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience |journal=Clin. Gastroenterol. Hepatol. |volume=4 |issue=8 |pages=1010–6; quiz 934 |year=2006 |pmid=16843735 |doi=10.1016/j.cgh.2006.05.017 |url=}}</ref> | ||
* Type 1 AIP involves pancreas as one part of a systemic IgG4-positive disease. | * Type 1 AIP involves [[pancreas]] as one part of a systemic IgG4-positive disease. | ||
* Type 1 patients have high relapse rates when compared to type 2 patients. | * Type 1 AIP is more prevalent in males compared to females. | ||
* Type 1 patients have high relapse rates when compared to type 2 patients.<ref name="pmid20353791">{{cite journal |vauthors=Sah RP, Chari ST, Pannala R, Sugumar A, Clain JE, Levy MJ, Pearson RK, Smyrk TC, Petersen BT, Topazian MD, Takahashi N, Farnell MB, Vege SS |title=Differences in clinical profile and relapse rate of type 1 versus type 2 autoimmune pancreatitis |journal=Gastroenterology |volume=139 |issue=1 |pages=140–8; quiz e12–3 |year=2010 |pmid=20353791 |doi=10.1053/j.gastro.2010.03.054 |url=}}</ref> | |||
* Type 1 patients are usually older on presentation. | * Type 1 patients are usually older on presentation. | ||
* Type 1 patients have higher prevalence of increased IgG4 levels. | * Type 1 patients have higher prevalence of increased IgG4 levels. | ||
* Type 1 patients have greater extrapancreatic organ involvement compared to Type 2 AIP patients. | * Type 1 patients have greater extrapancreatic [[Organ (anatomy)|organ]] involvement compared to Type 2 AIP patients. | ||
{| class="wikitable" | {| class="wikitable" | ||
!Criteria | !Criteria | ||
! | !Definition | ||
|- | |- | ||
!(H) | |||
|'''Histology''' suggestive of autoimmine pancreatitis | |'''Histology''' suggestive of autoimmine pancreatitis | ||
|- | |- | ||
!(I) | |||
|Pancreatic '''imaging''' suggestive of autoimmine | |Pancreatic '''imaging''' suggestive of autoimmine pstricturess | ||
|- | |- | ||
!(S) | |||
|'''Serology''' (IgG4 ≥2 times the upper limit of normal) | |'''Serology''' (IgG4 ≥2 times the upper limit of normal) | ||
|- | |- | ||
!(O) | |||
|'''Other''' organ involvement | |'''Other''' organ involvement | ||
* Biliary strictures | * Biliary strictures | ||
* Parotid/lacrimal gland involvement | * [[Parotid]]/[[lacrimal gland]] involvement | ||
* Mediastinal lymphadenopathy | * [[Mediastinal lymphadenopathy]] | ||
* Retroperitoneal fibrosis | * [[Retroperitoneal fibrosis]] | ||
|- | |- | ||
!(Rt) | |||
|'''Response to steroid treatment''' | |'''Response to steroid treatment''' | ||
|} | |||
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{| class="infobox" style="position: fixed; top: 65%; right: 10px; margin: 0 0 0 0; border: 0; float: right;" | |||
|- | |||
| {{#ev:youtube|pwv_FtIqQbY|450}} | |||
|- | |||
|} | |} | ||
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* Type 2 consists of granulocytic lesions. | * Type 2 consists of granulocytic lesions. | ||
* Type 2 does not involve IgG4-positive cells. | * Type 2 does not involve IgG4-positive cells. | ||
* Type 2 has no systemic involvement. | * Type 2 has no [[systemic]] involvement. | ||
* Type 2 AIP is usually associated with inflammatory bowel disease. | * Type 2 has same predilection for both sexes. | ||
* Type 2 AIP is usually associated with [[inflammatory bowel disease]] such as [[ulcerative colitis]]. | |||
==References== | ==References== | ||
Latest revision as of 15:13, 16 January 2018
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Autoimmune pancreatitis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Autoimmune pancreatitis classification On the Web |
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American Roentgen Ray Society Images of Autoimmune pancreatitis classification |
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Risk calculators and risk factors for Autoimmune pancreatitis classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]
Overview
Autoimmune pancreatitis may be classified into two types; type 1 AIP and type 2 AIP or idiopathic duct-centric pancreatitis. Type 1 AIP meets the HISORt criteria, involves pancreas as one part of a systemic IgG4-positive disease. Type 2 consists of granulocytic lesions, does not involve IgG4-positive cells, has no systemic involvement, and is usually associated with inflammatory bowel disease.
Classification
- Autoimmune pancreatitis can be:[1][2][3][4][5][6][7][8][9]
- Primary (when main pathology is in pancreas) or,
- Secondary (when associated with other systemic autoimmune diseases such as IgG4-associated cholangitis, chronic sclerosing sialadenitis, tubulointerstitial nephritis, and ulcerative colitis).
- Autoimmune pancreatitis may be classified into two types:
- Type 1 AIP.
- Type 2 AIP or idiopathic duct-centric pancreatitis.
Type 1 AIP:
- Type 1 AIP meets the HISORt criteria.[10][11]
- Type 1 AIP involves pancreas as one part of a systemic IgG4-positive disease.
- Type 1 AIP is more prevalent in males compared to females.
- Type 1 patients have high relapse rates when compared to type 2 patients.[12]
- Type 1 patients are usually older on presentation.
- Type 1 patients have higher prevalence of increased IgG4 levels.
- Type 1 patients have greater extrapancreatic organ involvement compared to Type 2 AIP patients.
| Criteria | Definition |
|---|---|
| (H) | Histology suggestive of autoimmine pancreatitis |
| (I) | Pancreatic imaging suggestive of autoimmine pstricturess |
| (S) | Serology (IgG4 ≥2 times the upper limit of normal) |
| (O) | Other organ involvement
|
| (Rt) | Response to steroid treatment |
| pwv_FtIqQbY|450}} |
Type 2 AIP or Idiopathic duct-centric pancreatitis:
- Type 2 consists of granulocytic lesions.
- Type 2 does not involve IgG4-positive cells.
- Type 2 has no systemic involvement.
- Type 2 has same predilection for both sexes.
- Type 2 AIP is usually associated with inflammatory bowel disease such as ulcerative colitis.
References
- ↑ Hirano K, Shiratori Y, Komatsu Y, Yamamoto N, Sasahira N, Toda N, Isayama H, Tada M, Tsujino T, Nakata R, Kawase T, Katamoto T, Kawabe T, Omata M (2003). "Involvement of the biliary system in autoimmune pancreatitis: a follow-up study". Clin. Gastroenterol. Hepatol. 1 (6): 453–64. PMID 15017645.
- ↑ Ghazale A, Chari ST, Zhang L, Smyrk TC, Takahashi N, Levy MJ, Topazian MD, Clain JE, Pearson RK, Petersen BT, Vege SS, Lindor K, Farnell MB (2008). "Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy". Gastroenterology. 134 (3): 706–15. doi:10.1053/j.gastro.2007.12.009. PMID 18222442.
- ↑ Raina A, Yadav D, Krasinskas AM, McGrath KM, Khalid A, Sanders M, Whitcomb DC, Slivka A (2009). "Evaluation and management of autoimmune pancreatitis: experience at a large US center". Am. J. Gastroenterol. 104 (9): 2295–306. doi:10.1038/ajg.2009.325. PMID 19532132.
- ↑ Tabata M, Kitayama J, Kanemoto H, Fukasawa T, Goto H, Taniwaka K (2003). "Autoimmune pancreatitis presenting as a mass in the head of the pancreas: a diagnosis to differentiate from cancer". Am Surg. 69 (5): 363–6. PMID 12769204.
- ↑ Erkelens GW, Vleggaar FP, Lesterhuis W, van Buuren HR, van der Werf SD (1999). "Sclerosing pancreato-cholangitis responsive to steroid therapy". Lancet. 354 (9172): 43–4. PMID 10406367.
- ↑ Kojima E, Kimura K, Noda Y, Kobayashi G, Itoh K, Fujita N (2003). "Autoimmune pancreatitis and multiple bile duct strictures treated effectively with steroid". J. Gastroenterol. 38 (6): 603–7. PMID 12856677.
- ↑ Horiuchi A, Kaneko T, Yamamura N, Nagata A, Nakamura T, Akamatsu T, Mukawa K, Kawa S, Kiyosawa K (1996). "Autoimmune chronic pancreatitis simulating pancreatic lymphoma". Am. J. Gastroenterol. 91 (12): 2607–9. PMID 8946997.
- ↑ Hamano H, Kawa S, Uehara T, Ochi Y, Takayama M, Komatsu K, Muraki T, Umino J, Kiyosawa K, Miyagawa S (2005). "Immunoglobulin G4-related lymphoplasmacytic sclerosing cholangitis that mimics infiltrating hilar cholangiocarcinoma: part of a spectrum of autoimmune pancreatitis?". Gastrointest. Endosc. 62 (1): 152–7. PMID 15990840.
- ↑ Church NI, Pereira SP, Deheragoda MG, Sandanayake N, Amin Z, Lees WR, Gillams A, Rodriguez-Justo M, Novelli M, Seward EW, Hatfield AR, Webster GJ (2007). "Autoimmune pancreatitis: clinical and radiological features and objective response to steroid therapy in a UK series". Am. J. Gastroenterol. 102 (11): 2417–25. doi:10.1111/j.1572-0241.2007.01531.x. PMID 17894845.
- ↑ Chari ST, Takahashi N, Levy MJ, Smyrk TC, Clain JE, Pearson RK, Petersen BT, Topazian MA, Vege SS (2009). "A diagnostic strategy to distinguish autoimmune pancreatitis from pancreatic cancer". Clin. Gastroenterol. Hepatol. 7 (10): 1097–103. doi:10.1016/j.cgh.2009.04.020. PMID 19410017.
- ↑ Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, Zhang L, Clain JE, Pearson RK, Petersen BT, Vege SS, Farnell MB (2006). "Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience". Clin. Gastroenterol. Hepatol. 4 (8): 1010–6, quiz 934. doi:10.1016/j.cgh.2006.05.017. PMID 16843735.
- ↑ Sah RP, Chari ST, Pannala R, Sugumar A, Clain JE, Levy MJ, Pearson RK, Smyrk TC, Petersen BT, Topazian MD, Takahashi N, Farnell MB, Vege SS (2010). "Differences in clinical profile and relapse rate of type 1 versus type 2 autoimmune pancreatitis". Gastroenterology. 139 (1): 140–8, quiz e12–3. doi:10.1053/j.gastro.2010.03.054. PMID 20353791.