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Review
. 2014 Nov 28;20(44):16559-69.
doi: 10.3748/wjg.v20.i44.16559.

Diagnosis of autoimmune pancreatitis

Hiroyuki Matsubayashi  1 , Naomi Kakushima  1 , Kohei Takizawa  1 , Masaki Tanaka  1 , Kenichiro Imai  1 , Kinichi Hotta  1 , Hiroyuki Ono  1
Affiliations
Review

Diagnosis of autoimmune pancreatitis

Hiroyuki Matsubayashi et al. World J Gastroenterol. .

Abstract

Autoimmune pancreatitis (AIP) is a distinct form of chronic pancreatitis that is increasingly being reported. The presentation and clinical image findings of AIP sometimes resemble those of several pancreatic malignancies, but the therapeutic strategy differs appreciably. Therefore, accurate diagnosis is necessary for cases of AIP. To date, AIP is classified into two distinct subtypes from the viewpoints of etiology, serum markers, histology, other organ involvements, and frequency of relapse: type 1 is related to IgG4 (lymphoplasmacytic sclerosing pancreatitis) and type 2 is related to a granulocytic epithelial lesion (idiopathic duct-centric chronic pancreatitis). Both types of AIP are characterized by focal or diffuse pancreatic enlargement accompanied with a narrowing of the main pancreatic duct, and both show dramatic responses to corticosteroid. Unlike type 2, type 1 is characteristically associated with increasing levels of serum IgG4 and positive serum autoantibodies, abundant infiltration of IgG4-positive plasmacytes, frequent extrapancreatic lesions, and relapse. These findings have led several countries to propose diagnostic criteria for AIP, which consist of essentially similar diagnostic items; however, several differences exist for each country, mainly due to differences in the definition of AIP and the modalities used to diagnose this disease. An attempt to unite the diagnostic criteria worldwide was made with the publication in 2011 of the international consensus diagnostic criteria for AIP, established at the 2010 Congress of the International Association of Pancreatology (IAP).

Keywords: Autoimmune pancreatitis; Criteria; Diagnosis; International consensus diagnostic criteria; Japanese.

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Figures

Figure 1
Figure 1
Algorithm of international consensus diagnostic criteria to diagnose type 1 autoimmune pancreatitis in subjects presenting with obstructive jaundice and/or pancreatic enlargement. This schematic drawing shows a flow to diagnose type 1 AIP with typical diffuse enlargement of the pancreas on CT/MRI (level 1 parenchymal findings)[25]. AIP: Autoimmune pancreatitis; CT: Computed tomography; MRI: Magnetic resonance image.
Figure 2
Figure 2
Algorithm of international consensus diagnostic criteria to diagnose type 1 autoimmune pancreatitis in subjects presenting with obstructive jaundice and/or pancreatic mass. This schematic drawing shows a flow to diagnose type 1 AIP with indeterminate or atypical findings of the pancreas on CT/MRI (level 2 parenchymal findings)[25]. AIP: Autoimmune pancreatitis; CT: Computed tomography; MRI: Magnetic resonance image; OOI: Other organ involvement.
Figure 3
Figure 3
Algorithm of international consensus diagnostic criteria to diagnose type 2 autoimmune pancreatitis in subjects presenting with obstructive jaundice and/or pancreatic mass. This schematic drawing shows a flow to diagnose type 2 AIP with typical/indeterminate (atypical) findings of the pancreas on CT/MRI (level 1 and 2 parenchymal findings)[25]. AIP: Autoimmune pancreatitis; IBD: Inflammatory bowel disease; IDCP: Idiopathic duct-centric chronic pancreatitis.
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