- By sahlhealth
- May 18, 2021
- 18 views
Autoimmune Pancreatitis, also called AIP, is a chronic inflammation that is thought to be caused by the body’s immune system attacking the pancreas and that responds to steroid therapy. Two subtypes of AIP are now recognized, type 1 and type 2.Type 1 AIP is also called IgG4-related pancreatitis and is part of a disease called IgG4-related disease (IgG4-RD) that often affects multiple organs including the pancreas, bile ducts in the liver, salivary glands, kidneys and lymph nodes.Type 2 AIP, also called idiopathic duct-centric pancreatitis, seems to affect only the pancreas, although about one-third of people with type 2 AIP have associated inflammatory bowel disease.Autoimmune Pancreatitis is a rare, newly recognized disease and can be mistakenly diagnosed as pancreatic cancer. The two conditions have similar signs and symptoms, but very different treatments, so it is very important to distinguish one from another.
-Autoimmune Pancreatitis (AIP) is difficult to diagnose. Often, it doesn't cause any symptoms. When it does, its symptoms and signs are similar to those of pancreatic cancer.
Pancreatic cancer symptoms can include:
- Dark urine
- Pale stools or stools that float in the toilet
- Yellow skin and eyes (jaundice)
- Pain in your upper abdomen or middle part of your back
- Nausea and vomiting
- Weakness or extreme tiredness
- Loss of appetite or feelings of fullness
- Weight loss for no known reason
-The most common sign of Autoimmune Pancreatitis, present in about 80 percent of people, is painless jaundice, caused by blocked bile ducts. AIP can also cause weight loss.Many people with Autoimmune Pancreatitis have masses in the pancreas and other organs, which can be misdiagnosed as cancer.
Other differences between type 1 and type 2 AIP are:
-In type 1 AIP, the disease may affect other organs in addition to the pancreas. Type 2 AIP affects only the pancreas, although the disease is associated with another Autoimmune condition, inflammatory bowel disease.
- Type 1 AIP responds rapidly to treatment with steroids.
- Type 1 AIP is likely to relapse if treatment is discontinued.
-Autoimmune Pancreatitis is difficult to diagnose, because its signs and symptoms are very similar to those of pancreatic cancer. However, an accurate diagnosis is extremely important. Undiagnosed cancer may result in delaying or not receiving necessary surgery.People with AIP tend to have a general enlargement of the pancreas, but they may also have a mass in the pancreas. To pinpoint the diagnosis and determine which type of AIP you have, blood and imaging tests are necessary.
-No single test or characteristic feature identifies Autoimmune Pancreatitis. Until recently, different diagnostic approaches around the world made the diagnosis more difficult.Sometimes, surgery is necessary to exclude pancreatic cancer.
Specific tests may include:
- Imaging tests. Tests of your pancreas and other organs may include CT, MRI, endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatograph (ERCP).
- Blood tests. You will be tested for elevated levels of an immunoglobulin called IgG4, produced by your immune system. People with type 1 AIP, but not with type 2 AIP, will have highly elevated blood levels of IgG4.However a positive test doesn't necessarily mean that you have the disease. A small number of people who don't have Autoimmune Pancreatitis, including some with pancreatic cancer, also have high blood levels of IgG4.
- Endoscopic core biopsy. In this test, pathologists analyze a sample of pancreatic tissue in the laboratory. AIP has a distinctive appearance that is easily recognized under a microscope. Doctors insert a small tube (endoscope) through the mouth into the stomach and, guided by ultrasound, remove some tissue from the pancreas using a special needle.The challenge is obtaining a sample of tissue large enough to analyze, rather than just a few cells. This procedure is not widely available, and results may not be conclusive.
- Steroid trial. Because Autoimmune Pancreatitis is the only pancreatic disorder known to respond to steroids, doctors sometimes use a trial course of this drug to confirm a diagnosis. Response to corticosteroids is measured by CT and improvement in serum IgG4 levels.
- Biliary stenting. Before starting medication, sometimes doctors will insert a tube to drain the biliary ducts (biliary stenting) in people with symptoms of obstructive jaundice.Often, though, jaundice improves with steroid treatment alone. Sometimes drainage is recommended if the diagnosis is uncertain.
- Steroids. Symptoms of autoimmune pancreatitis often improve after a short course of prednisolone or prednisone. Many people respond quickly, even dramatically. Sometimes people get better without any treatment.
- Immunosuppressants and immunomodulators. About 30 to 50 percent of the time, AIP returns, requiring additional treatment, sometimes long term. To help reduce the serious side effects associated with extended steroid use, doctors often add drugs that suppress or modify the immune system, sometimes called steroid-sparing medications, to the treatment. You may be able to stop taking steroids altogether .Immunosuppressants and immunomodulators include mercaptopurine (Purinethol, Purixan), azathioprine (Imuran, Azasan) and rituximab (Rituxan). In general, they have been used in small sample groups and long-term benefits are still being studied.
- Treatment for pancreatic insufficiency. If you have insufficient pancreatic enzymes, you may need supplementary enzymes. If you need supplements, your doctor will prescribe pancreatic enzymes (Creon, Viokace, Pancreaze, Zenpep, Pertzye). The over-the-counter versions of these drugs are not regulated by the Food and Drug Administration.
- Treatment for diabetes. If you have diabetes, you will need appropriate treatment.
- Monitoring of other organ involvement. Type 1 AIP often is associated with other organ involvement, including enlarged lymph nodes and salivary glands, scarring of the bile ducts, liver inflammation, and kidney disease. Although these signs may lessen or disappear completely with steroid therapy, your doctor will continue to monitor you.