Pathology

An Overview of Autoimmune Pancreatitis



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Autoimmune pancreatitis is an inflammatory disease of the pancreas which takes place as a result of the body’s own immune mechanisms acting on its own tissues. It is a difficult disease to diagnose as it can closely resemble a pancreatic cancer both with its appearance as well as by its symptoms. However, although it is a chronic disease, autoimmune pancreatitis often responds well to medicines and therefore could be managed well without developing further complications.

Who are more susceptible to develop this disease?

According to experts, autoimmune pancreatitis usually takes place among men who are in their 50s and 60s although some variations of autoimmune pancreatitis can occur at a much younger age as well.

What are the signs and symptoms of autoimmune pancreatitis?

The signs and symptoms of autoimmune pancreatitis could be vague in its early stages and some of these symptoms may include mild to moderate abdominal pain, flatulence, indigestion, nausea, weight loss…etc. However, there may not be a sudden severe pain, as in the case of acute pancreatitis, among those patients who are suffering from the autoimmune form of the disease. As the disease progress, the common bile duct which drains both the pancreatic juice and bile could be blocked and this can lead to a condition known as ‘jaundice’ which is a yellowing of the skin and the mucous membranes. If left untreated, autoimmune pancreatitis can progress towards giving rise to liver failure or even kidney disease.

How the autoimmune pancreatitis is diagnosed?

There is no single test to diagnose autoimmune pancreatitis and it is a combination of imaging studies, blood tests, biopsy analysis as well as treatment trials which enable an accurate diagnosis.

Physicians will make use of CT scans and ultrasound scans to perform the initial evaluation, if they suspect of a problem related to the pancreas, liver or the common bile duct. It will show any enlargement, shrinking or tumors that may be present in the vicinity.

Blood tests will also be carried out in order to identify a raised IgG4 level which indicates the possibility of an immune mediated mechanism most likely to be an autoimmune disease.

Endoscopic studies will also be useful both to obtain a piece of tissue from the pancreas as well as to assess the blockage that may have been caused to the common bile duct or other draining tubes.

Finally, when the diagnosis is inconclusive, physician will want to do a treatment trial with corticosteroids, which if responding can cause the IgG4 levels to drop or reduce the size of a swelling or of a tumor.

How is the condition treated?

The mainstay of the treatment will be steroids and almost all will respond to the treatment rather quickly. However, according to the Mayo clinic, around 60% of the patients would experience a relapse. But, by adding steroid sparing medications to the treatment programme, it is possible to lessen this risk as well as allow the patients to take a lower dose of steroid medications than usually required.

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