Autoimmune pancreatitis complicated with inflammatory bowel disease and comparative study of type 1 and type 2 autoimmune pancreatitis

Shigeyuki Kawa, Kazuichi Okazaki, Kenji Notohara, Mamoru Watanabe, Tooru Shimosegawa, Toshiharu Ueki, Toshiyuki Matsui, Atsushi Kanno, Takayuki Watanabe, Kazushige Uchida, Masashi Taguchi, Hisato Igarashi, Tetsuhide Ito, Hiroaki Igarashi, Takeshi Kawanobe, Hideki Iijima, Yutaka Kohgo, Takahiro Ito, Reiko Kunisaki, Masakazu NagahoriTakao Itoi, Mitsuyoshi Honjo, Junichi Sakagami, Hiroaki Yasuda, Katsuyoshi Hatakeyama, Tsuneo Iiai, Yoshiki Hirooka, Hajime Sumi, Kenji Watanabe, Makoto Sasaki, Akira Ando, Osamu Inatomi, Fukunori Kinjo, Atsushi Iraha, Naotaka Fujita, Kaori Mas, Takashi Kagaya, Hiroyuki Miyakawa, Keiya Okamura, Toshifumi Hibi, Yuji Nakamura, Katsuyuki Fukuda, Tsukasa Ikeura, Takuya Ishikawa, Fumiaki Ueno, Akihiko Satoh, Masato Uemura, Hirohito Tsubouchi, Keita Funakawa, Masahiro Iizuka, Atsushi Yoden, Kensuke Kubota, Yuji Funayama, Takaaki Eguchi, Yoh Ishiguro, Natsumi Uehara, Norikazu Arakura, Terumi Kamisawa, Isao Nishimori, Hirotaka Ohara, Nobumasa Mizuno, Kenji Hirano, Atsushi Masamune, Kazuhiro Kikuta, Group for Pancreatitis Complicated with Inflammatory Bowel Disease organized by The Research Study Group for Pancreatitis Complicated with Inflammatory Bowel Disease organized by The Research

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15 Citations (Scopus)

Abstract

Background: Two types of autoimmune pancreatitis (AIP) have been reported, lymphoplasmacytic sclerosing pancreatitis and idiopathic duct-centric chronic pancreatitis (IDCP), which are now recognized as type 1 and type 2 AIP, respectively. Since the clinical features of type 2 AIP have not been fully elucidated and this condition is frequently accompanied by inflammatory bowel disease (IBD), we performed a nationwide survey of patients with AIP complicated with IBD to precisely characterize this disease entity. Methods: We collected 138 cases of pancreatitis with complicating IBD from affiliated institutes specializing in AIP or IBD, and comparative study between the IDCP groups and type 1 AIP was performed. Results: Histological examination revealed 15 AIP cases to be IDCP of institutional diagnosis, among which 11 cases were upgraded to IDCP of central diagnosis by an expert pathologist. The IDCP group exhibited younger onset age, no gender bias, frequent abdominal pain, and normal IgG4 value, similar to those of type 2 AIP reported previously. We also witnessed a lower prevalence of jaundice in type 2 AIP than in type 1 AIP that corresponded to imaging findings of less frequent pancreatic head swelling and scarce bile duct stenosis. Conclusions: A characteristic feature of type 2 AIP compared with type 1 AIP is a low frequency of obstructive jaundice that is related to rare lower bile duct stricture due to lower prevalence of pancreatic head swelling. Contrary to type 1 AIP, lower bile duct stricture in this condition has no apparent relation to sclerosing cholangitis.

Original languageEnglish
Pages (from-to)805-815
Number of pages11
JournalJournal of gastroenterology
Volume50
Issue number7
DOIs
Publication statusPublished - 2015 Jul 21

Keywords

  • Autoimmune pancreatitis (AIP)
  • Crohn’s disease
  • Granulocytic epithelial lesion (GEL)
  • Idiopathic duct-centric chronic pancreatitis (IDCP)
  • Inflammatory bowel disease (IBD)
  • Lymphoplasmacytic sclerosing pancreatitis (LPSP)
  • Ulcerative colitis (UC)

ASJC Scopus subject areas

  • Gastroenterology

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    Kawa, S., Okazaki, K., Notohara, K., Watanabe, M., Shimosegawa, T., Ueki, T., Matsui, T., Kanno, A., Watanabe, T., Uchida, K., Taguchi, M., Igarashi, H., Ito, T., Igarashi, H., Kawanobe, T., Iijima, H., Kohgo, Y., Ito, T., Kunisaki, R., ... Study Group for Pancreatitis Complicated with Inflammatory Bowel Disease organized by The Research, G. F. P. C. W. I. B. D. O. B. T. R. (2015). Autoimmune pancreatitis complicated with inflammatory bowel disease and comparative study of type 1 and type 2 autoimmune pancreatitis. Journal of gastroenterology, 50(7), 805-815. https://doi.org/10.1007/s00535-014-1012-5