Treatment and relapse of autoimmune pancreatitis

Abstract

Autoimmune pancreatitis (AIP) is a peculiar type of chronic pancreatitis whose pathogenesis involves autoimmune mechanisms. The steroid responsiveness has a significant impact on the diagnosis of AIP because patients with AIP and pancreatic cancer share many clinical features. This review focuses on the treatment and relapse of AIP. The goal of AIP treatment is remission of symptoms, serology, radiologic changes, or histology, which also applies to relapse. Although it is generally agreed that steroids should be offered to AIP patients with active disease, there is no standardized steroid regimen for AIP and no consensus on the dose and duration of steroid induction and tapering schedule, and optimal duration and dose of maintenance therapy. Obtaining a consensus on the optimal treatment regimen is very important to reducing the relapse rate. In this review, we discuss the treatment regimens used in many centers.

Keywords: Autoimmune pancreatitis; Relapse; Treatment.

Fig. 1

Algorithm for the management of autoimmune pancreatitis.

Fig. 2

Serial images of a 67-year-old man with AIP. First attack: (A, B) Before steroid therapy, CT scans show diffuse pancreatic enlargement and ERCP show narrowing (arrow) of the distal common bile duct (CBD) and dilatation of the proximal CBD. (C, D) After steroid therapy, pancreatic enlargement improves with resolution of CBD dilatation. On relapse: (E) Before steroid therapy, MRCP shows multifocal strictures at the hilar and intrahepatic bile ducts without pancreatic duct involvement. (F) After steroid retreatment, multifocal biliary strictures are being resolved. AIP, autoimmune pancreatitis.