Skip to main content

Advertisement

SpringerLink
Log in

Autoimmune Pancreatitis: An Update on Classification, Diagnosis, Natural History and Management

  • Pancreas (CE Forsmark, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Autoimmune Pancreatitis (AIP) is a recently recognized chronic fibro-inflammatory disease of the pancreas. Although rare, its recognition continues to increase worldwide. Patients often present with painless obstructive jaundice mimicking pancreatic cancer. Two subtypes of AIP are known-type 1 is a multi-organ disease associated with IgG4; type 2 appears to be a pancreas-specific disorder. Dramatic response to steroid treatment is characteristic of both forms. A non-invasive diagnosis of type 1 AIP may be possible using diagnostic criteria (in ~70% cases) while diagnosis of type 2 requires histology. These subtypes differ in natural history- type 1 often relapses while initial reports suggest that type 2 does not. Long term complications include endocrine and exocrine insufficiency and in case of type 1, disease relapses and complications from extra-pancreatic involvement. Neither form affects long term survival. The treatment and follow-up guidelines continue to evolve with our increasing experience in AIP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Sarles H, Sarles JC, Muratore R, et al. Chronic inflammatory sclerosis of the pancreas–an autonomous pancreatic disease? Am J Dig Dis. 1961;6:688–98.

    Article  PubMed  CAS  Google Scholar 

  2. Yoshida K, Toki F, Takeuchi T, et al. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci. 1995;40(7):1561–8.

    Article  PubMed  CAS  Google Scholar 

  3. Pearson RK, Longnecker DS, Chari ST, et al. Controversies in clinical pancreatology: autoimmune pancreatitis: does it exist? Pancreas. 2003;27(1):1–13.

    Article  PubMed  Google Scholar 

  4. Chari ST, Smyrk TC, Levy MJ, et al. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol. 2006;4(8):1010–6. quiz 934.

    Article  PubMed  Google Scholar 

  5. •• Kamisawa T, Chari ST, Giday SA, et al. Clinical profile of autoimmune pancreatitis and its histological subtypes: an international multicenter survey. Pancreas 40(6):809–14. An important study analyzing data from cohorts around the world and specifically examining biopsy-unproven cases of AIP worldwide.

  6. Raina A, Yadav D, Krasinskas AM, et al. Evaluation and management of autoimmune pancreatitis: experience at a large US center. Am J Gastroenterol. 2009;104(9):2295–306.

    Article  PubMed  Google Scholar 

  7. • Park DH, Kim MH, Chari ST. Recent advances in autoimmune pancreatitis. Gut 2009;58(12):1680–9. A comprehensive review of AIP including discussion on pathogenesis of type 1 and type 2 AIP.

    Article  PubMed  CAS  Google Scholar 

  8. Ryu JK, Chung JB, Park SW, et al. Review of 67 patients with autoimmune pancreatitis in Korea: a multicenter nationwide study. Pancreas. 2008;37(4):377–85.

    Article  PubMed  Google Scholar 

  9. Song Y, Liu QD, Zhou NX, et al. Diagnosis and management of autoimmune pancreatitis: experience from China. World J Gastroenterol. 2008;14(4):601–6.

    Article  PubMed  Google Scholar 

  10. •• Kamisawa T, Shimosegawa T, Okazaki K, et al. Standard steroid treatment for autoimmune pancreatitis. Gut 2009;58(11):1504–7. A large multicenter cohort from Japan describing the treatment and response to treatment including relapse in AIP.

    Article  PubMed  CAS  Google Scholar 

  11. Church NI, Pereira SP, Deheragoda MG, et al. Autoimmune pancreatitis: clinical and radiological features and objective response to steroid therapy in a UK series. Am J Gastroenterol. 2007;102(11):2417–25.

    Article  PubMed  CAS  Google Scholar 

  12. • Frulloni L, Scattolini C, Falconi M, et al. Autoimmune pancreatitis: differences between the focal and diffuse forms in 87 patients. Am J Gastroenterol. 2009;104(9):2288–94. A different approach to classifying AIP based on initial radiology into diffuse and focal forms, from a large cohort in Italy.

    Article  PubMed  Google Scholar 

  13. Noor MT, Lal A, Kochhar R, et al. Autoimmune pancreatitis: a report from India. JOP 11(3):213–9.

  14. Maire F, Le Baleur Y, Rebours V, et al. Outcome of patients with type 1 or 2 autoimmune pancreatitis. Am J Gastroenterol. 106(1):151–6.

  15. Czako L, Gyokeres T, Topa L, et al. Autoimmune pancreatitis in Hungary: a multicenter nationwide study. Pancreatology 11(2):261–7.

  16. Sandanayake NS, Church NI, Chapman MH, et al. Presentation and management of post-treatment relapse in autoimmune pancreatitis/immunoglobulin G4-associated cholangitis. Clin Gastroenterol Hepatol. 2009;7(10):1089–96.

    Article  PubMed  CAS  Google Scholar 

  17. •• Chari ST, Takahashi N, Levy MJ, et al. A diagnostic strategy to distinguish autoimmune pancreatitis from pancreatic cancer. Clin Gastroenterol Hepatol. 2009;7(10):1097–103. An important study that validates the diagnostic approach that forms the basis of the revised HISORt criteria and the new ICDC criteria described in this review. This study showed that more than 70% of type 1 AIP diagnosis can be made non-invasively.

    Article  CAS  Google Scholar 

  18. Sugumar A, Chari ST. Distinguishing pancreatic cancer from autoimmune pancreatitis: a comparison of two strategies. Clin Gastroenterol Hepatol. 2009;7(11 Suppl):S59–62.

    Article  PubMed  Google Scholar 

  19. Sugumar A, Takahashi N, Chari ST. Distinguishing pancreatic cancer from autoimmune pancreatitis. Curr Gastroenterol Rep. 12(2):91–7.

  20. Hamano H, Kawa S, Horiuchi A, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med. 2001;344(10):732–8.

    Article  PubMed  CAS  Google Scholar 

  21. Kamisawa T. IgG4-positive plasma cells specifically infiltrate various organs in autoimmune pancreatitis. Pancreas. 2004;29(2):167–8.

    Article  PubMed  Google Scholar 

  22. Kamisawa T, Funata N, Hayashi Y. Lymphoplasmacytic sclerosing pancreatitis is a pancreatic lesion of IgG4-related systemic disease. Am J Surg Pathol. 2004;28(8):1114.

    Article  PubMed  Google Scholar 

  23. Zamboni G, Luttges J, Capelli P, et al. Histopathological features of diagnostic and clinical relevance in autoimmune pancreatitis: a study on 53 resection specimens and 9 biopsy specimens. Virchows Arch. 2004;445(6):552–63.

    Article  PubMed  Google Scholar 

  24. Zhang L, Notohara K, Levy MJ, et al. IgG4-positive plasma cell infiltration in the diagnosis of autoimmune pancreatitis. Mod Pathol. 2007;20(1):23–8.

    Article  PubMed  CAS  Google Scholar 

  25. Notohara K, Burgart LJ, Yadav D, et al. Idiopathic chronic pancreatitis with periductal lymphoplasmacytic infiltration: clinicopathologic features of 35 cases. Am J Surg Pathol. 2003;27(8):1119–27.

    Article  PubMed  Google Scholar 

  26. •• Sah RP, Chari ST, Pannala R, et al. Differences in clinical profile and relapse rate of type 1 versus type 2 autoimmune pancreatitis. Gastroenterology 139(1):140–8; quiz e12-3. This study described the clinical profile of type 1 and type 2 AIP for the first time. Also the first data on long term follow-up of AIP including survival and relapse.

  27. •• Chari ST, Kloeppel G, Zhang L, et al. Histopathologic and clinical subtypes of autoimmune pancreatitis: the Honolulu consensus document. Pancreas 39(5):549–54. A consensus document emerging from the important 40th APA and JPS joint meeting discussion on the classification of AIP. A popular meeting widely attended from experts all around the world, this document summarizes the important discussion on the recognition of type 1 and type 2 AIP as distinct subtypes.

  28. •• Shimosegawa T, Chari ST, Frulloni L, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 40(3):352–8. This paper introduces and describes the ICDC criteria for the diagnosis of AIP (type 1 and type 2).

  29. • Chari ST, Longnecker DS, Kloppel G. The diagnosis of autoimmune pancreatitis: a Western perspective. Pancreas 2009;38(8):846–8. An important discussion on the implication on the diagnosis of AIP after the recognition of two distinct subtypes.

    Article  PubMed  Google Scholar 

  30. Deshpande V, Gupta R, Sainani N, et al. Subclassification of autoimmune pancreatitis: a histologic classification with clinical significance. Am J Surg Pathol. 35(1):26–35.

  31. Sugumar A, Kloppel G, Chari ST. Autoimmune pancreatitis: pathologic subtypes and their implications for its diagnosis. Am J Gastroenterol. 2009;104(9):2308–10. quiz 11.

    Article  PubMed  Google Scholar 

  32. • Kloppel G, Detlefsen S, Chari ST, et al. Autoimmune pancreatitis: the clinicopathological characteristics of the subtype with granulocytic epithelial lesions. J Gastroenterol. 45(8):787–93. This imporatnt study describes the histology features of type 2 AIP.

  33. Hamano H, Arakura N, Muraki T, et al. Prevalence and distribution of extrapancreatic lesions complicating autoimmune pancreatitis. J Gastroenterol. 2006;41(12):1197–205.

    Article  PubMed  Google Scholar 

  34. • Naitoh I, Nakazawa T, Ohara H, et al. Clinical significance of extrapancreatic lesions in autoimmune pancreatitis. Pancreas 39(1):e1–5. A comprehensive study describing extra-pancreatic manifestations in AIP.

  35. Kamisawa T, Okamoto A. IgG4-related sclerosing disease. World J Gastroenterol. 2008;14(25):3948–55.

    Article  PubMed  CAS  Google Scholar 

  36. Kamisawa T, Takuma K, Tabata T, et al. Serum IgG4-negative autoimmune pancreatitis. J Gastroenterol. 46(1):108–16.

  37. • Sah RP, Chari ST. Serologic issues in IgG4-related systemic disease and autoimmune pancreatitis. Curr Opin Rheumatol. 23(1):108–13. An important review on the role of IgG4 in the diagnosis and follow-up of AIP.

  38. Tabata T, Kamisawa T, Takuma K, et al. Serial changes of elevated serum IgG4 levels in IgG4-related systemic disease. Intern Med. 50(2):69–75.

  39. Levy MJ, Smyrk TC, Takahashi N, et al. Idiopathic duct-centric pancreatitis: disease description and endoscopic ultrasonography-guided trucut biopsy diagnosis. Pancreatology 11(1):76–80.

  40. Gardner TB, Levy MJ, Takahashi N, et al. Misdiagnosis of autoimmune pancreatitis: a caution to clinicians. Am J Gastroenterol. 2009;104(7):1620–3.

    Article  PubMed  Google Scholar 

  41. Okazaki K, Kawa S, Kamisawa T, et al. Japanese consensus guidelines for management of autoimmune pancreatitis: I. Concept and diagnosis of autoimmune pancreatitis. J Gastroenterol. 45(3):249–65.

  42. Otsuki M, Chung JB, Okazaki K, et al. Asian diagnostic criteria for autoimmune pancreatitis: consensus of the Japan-Korea Symposium on Autoimmune Pancreatitis. J Gastroenterol. 2008;43(6):403–8.

    Article  PubMed  CAS  Google Scholar 

  43. Schneider A, Lohr JM, Singer MV. The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol. 2007;42(2):101–19.

    Article  PubMed  Google Scholar 

  44. Sah RP, Pannala R, Chari ST, et al. Prevalence, diagnosis, and profile of autoimmune pancreatitis presenting with features of acute or chronic pancreatitis. Clin Gastroenterol Hepatol. 8(1):91–6.

  45. Nakazawa T, Ohara H, Sano H, et al. Clinical differences between primary sclerosing cholangitis and sclerosing cholangitis with autoimmune pancreatitis. Pancreas. 2005;30(1):20–5.

    PubMed  Google Scholar 

  46. • Ghazale A, Chari ST, Zhang L, et al. Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy. Gastroenterology 2008;134(3):706–15. An important cohort describing IgG4 associated Cholangitis (IAC), including treatment and relapse.

    Article  PubMed  Google Scholar 

  47. Yamamoto M, Harada S, Ohara M, et al. Clinical and pathological differences between Mikulicz’s disease and Sjogren’s syndrome. Rheumatology (Oxford). 2005;44(2):227–34.

    Article  CAS  Google Scholar 

  48. • Sugumar A, Levy MJ, Kamisawa T, et al. Endoscopic retrograde pancreatography criteria to diagnose autoimmune pancreatitis: an international multicentre study. Gut 60(5):666–70. A multicenter effort to recognize important ERP features of AIP and its utility in diagnosis. This study recognized the limited use currently of ERP features in diagnosis of AIP in the western setting.

  49. Moon SH, Kim MH, Park do H, et al. IgG4 immunostaining of duodenal papillary biopsy specimens may be useful for supporting a diagnosis of autoimmune pancreatitis. Gastrointest Endosc. 71(6):960–6.

  50. Kamisawa T, Tu Y, Egawa N, et al. A new diagnostic endoscopic tool for autoimmune pancreatitis. Gastrointest Endosc. 2008;68(2):358–61.

    Article  PubMed  Google Scholar 

  51. Rebours V, Le Baleur Y, Cazals-Hatem D, et al. IgG4 immunostaining of gastric, duodenal or colonic biopsies is not helpful for the diagnosis of autoimmune pancreatitis. Clin Gastroenterol Hepatol.

  52. Levy MJ. Endoscopic ultrasound-guided trucut biopsy of the pancreas: prospects and problems. Pancreatology. 2007;7(2–3):163–6.

    Article  PubMed  Google Scholar 

  53. Mizuno N, Bhatia V, Hosoda W, et al. Histological diagnosis of autoimmune pancreatitis using EUS-guided trucut biopsy: a comparison study with EUS-FNA. J Gastroenterol. 2009;44(7):742–50.

    Article  PubMed  CAS  Google Scholar 

  54. •• Pannala R, Chari ST. Corticosteroid treatment for autoimmune pancreatitis. Gut 2009;58(11):1438–9. An rigorous discussion on the differences in treatment practices in the US and Japan and its implications based on available experience.

    Article  PubMed  CAS  Google Scholar 

  55. Ghazale A, Chari ST. Optimising corticosteroid treatment for autoimmune pancreatitis. Gut. 2007;56(12):1650–2.

    Article  PubMed  CAS  Google Scholar 

  56. Moon SH, Kim MH, Park DH, et al. Is a 2-week steroid trial after initial negative investigation for malignancy useful in differentiating autoimmune pancreatitis from pancreatic cancer? A prospective outcome study. Gut. 2008;57(12):1704–12.

    Article  PubMed  CAS  Google Scholar 

  57. Hirano K, Tada M, Isayama H, et al. Long-term prognosis of autoimmune pancreatitis with and without corticosteroid treatment. Gut. 2007;56(12):1719–24.

    Article  PubMed  CAS  Google Scholar 

  58. Kamisawa T, Okazaki K, Kawa S, et al. Japanese consensus guidelines for management of autoimmune pancreatitis: III. Treatment and prognosis of AIP. J Gastroenterol. 45(5):471–7.

  59. Chari ST, Murray JA. Autoimmune pancreatitis, Part II: the relapse. Gastroenterology. 2008;134(2):625–8.

    Article  PubMed  CAS  Google Scholar 

  60. Sah RP, Chari ST. Long Term Prognosis in IgG4-related Systemic Disease (ISD). Curr Immunol Rev. 7(2):239–45.

  61. Kubota K, Iida H, Fujisawa T, et al. Clinical factors predictive of spontaneous remission or relapse in cases of autoimmune pancreatitis. Gastrointest Endosc. 2007;66(6):1142–51.

    Article  PubMed  Google Scholar 

  62. Kawa S, Hamano H, Ozaki Y, et al. Long-term follow-up of autoimmune pancreatitis: characteristics of chronic disease and recurrence. Clin Gastroenterol Hepatol. 2009;7(11 Suppl):S18–22.

    Article  PubMed  CAS  Google Scholar 

  63. Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003;348(26):2646–55.

    Article  PubMed  Google Scholar 

  64. Johnson PJ, McFarlane IG, Williams R. Azathioprine for long-term maintenance of remission in autoimmune hepatitis. N Engl J Med. 1995;333(15):958–63.

    Article  PubMed  CAS  Google Scholar 

  65. Park do H, Kim MH, Oh HB, et al. Substitution of aspartic acid at position 57 of the DQbeta1 affects relapse of autoimmune pancreatitis. Gastroenterology. 2008;134(2):440–6.

    Article  PubMed  Google Scholar 

  66. Hirano K, Asaoka Y, Tada M, et al. No significant relation between relapse of autoimmune pancreatitis and substitution of aspartic acid at position 57 of DQbeta1. J Gastroenterol. 2009;44(7):799–800.

    Article  PubMed  Google Scholar 

  67. Topazian M, Witzig TE, Smyrk TC, et al. Rituximab therapy for refractory biliary strictures in immunoglobulin G4-associated cholangitis. Clin Gastroenterol Hepatol. 2008;6(3):364–6.

    Article  PubMed  CAS  Google Scholar 

  68. Sugumar A, Chari ST. Diagnosis and treatment of autoimmune pancreatitis. Curr Opin Gastroenterol. 26(5):513–8.

  69. Ghazale A, Chari S. Is autoimmune pancreatitis a risk factor for pancreatic cancer? Pancreas. 2007;35(4):376.

    Article  PubMed  Google Scholar 

  70. Loos M, Esposito I, Hedderich DM, et al. Autoimmune pancreatitis complicated by carcinoma of the pancreatobiliary system: a case report and review of the literature. Pancreas 40(1):151–4.

  71. Uchida K, Yazumi S, Nishio A, et al. Long-term outcome of autoimmune pancreatitis. J Gastroenterol. 2009;44(7):726–32.

    Article  PubMed  CAS  Google Scholar 

  72. Inoue H, Miyatani H, Sawada Y, et al. A case of pancreas cancer with autoimmune pancreatitis. Pancreas. 2006;33(2):208–9.

    Article  PubMed  Google Scholar 

  73. Fukui T, Mitsuyama T, Takaoka M, et al. Pancreatic cancer associated with autoimmune pancreatitis in remission. Intern Med. 2008;47(3):151–5.

    Article  PubMed  Google Scholar 

  74. Motosugi U, Ichikawa T, Yamaguchi H, et al. Small invasive ductal adenocarcinoma of the pancreas associated with lymphoplasmacytic sclerosing pancreatitis. Pathol Int. 2009;59(10):744–7.

    Article  PubMed  Google Scholar 

  75. Ohtani H, Ishida H, Ito Y, et al. Autoimmune pancreatitis and biliary intraepithelial neoplasia of the common bile duct: a case with diagnostically challenging but pathogenetically significant association. Pathol Int. 61(8):481–5.

  76. Pezzilli R, Vecchiarelli S, Di Marco MC, et al. Pancreatic ductal adenocarcinoma associated with autoimmune pancreatitis. Case Rep Gastroenterol. 5(2):378–85.

  77. Kamisawa T, Tsuruta K, Okamoto A, et al. Frequent and significant K-ras mutation in the pancreas, the bile duct, and the gallbladder in autoimmune pancreatitis. Pancreas. 2009;38(8):890–5.

    Article  PubMed  CAS  Google Scholar 

  78. Kamisawa T, Okamoto A. Prognosis of autoimmune pancreatitis. J Gastroenterol. 2007;42 Suppl 18:59–62.

    Article  PubMed  CAS  Google Scholar 

  79. Nishino T, Toki F, Oyama H, et al. Long-term outcome of autoimmune pancreatitis after oral prednisolone therapy. Intern Med. 2006;45(8):497–501.

    Article  PubMed  Google Scholar 

  80. Takahashi N, Ghazale AH, Smyrk TC, et al. Possible association between IgG4-associated systemic disease with or without autoimmune pancreatitis and non-Hodgkin lymphoma. Pancreas. 2009;38(5):523–6.

    Article  PubMed  Google Scholar 

  81. Masaki Y, Dong L, Kurose N, et al. Proposal for a new clinical entity, IgG4-positive multiorgan lymphoproliferative syndrome: analysis of 64 cases of IgG4-related disorders. Ann Rheum Dis. 2009;68(8):1310–5.

    Article  PubMed  CAS  Google Scholar 

  82. Tanaka S, Kobayashi T, Nakanishi K, et al. Corticosteroid-responsive diabetes mellitus associated with autoimmune pancreatitis: pathological examinations of the endocrine and exocrine pancreas. Ann N Y Acad Sci. 2002;958:152–9.

    Article  PubMed  Google Scholar 

  83. Ito T, Kawabe K, Arita Y, et al. Evaluation of pancreatic endocrine and exocrine function in patients with autoimmune pancreatitis. Pancreas. 2007;34(2):254–9.

    Article  PubMed  CAS  Google Scholar 

  84. Kamisawa T, Egawa N, Inokuma S, et al. Pancreatic endocrine and exocrine function and salivary gland function in autoimmune pancreatitis before and after steroid therapy. Pancreas. 2003;27(3):235–8.

    Article  PubMed  CAS  Google Scholar 

  85. Nishimori I, Tamakoshi A, Kawa S, et al. Influence of steroid therapy on the course of diabetes mellitus in patients with autoimmune pancreatitis: findings from a nationwide survey in Japan. Pancreas. 2006;32(3):244–8.

    Article  PubMed  CAS  Google Scholar 

  86. Kim KP, Kim MH, Song MH, et al. Autoimmune chronic pancreatitis. Am J Gastroenterol. 2004;99(8):1605–16.

    Article  PubMed  Google Scholar 

  87. Frulloni L, Scattolini C, Katsotourchi AM, et al. Exocrine and endocrine pancreatic function in 21 patients suffering from autoimmune pancreatitis before and after steroid treatment. Pancreatology 10(2–3):129–33.

  88. Ito T, Nakamura T, Fujimori N, et al. Characteristics of pancreatic diabetes in patients with autoimmune pancreatitis. J Dig Dis. 12(3):210–6.

  89. Ravi K, Chari ST, Vege SS, et al. Inflammatory bowel disease in the setting of autoimmune pancreatitis. Inflamm Bowel Dis. 2009;15(9):1326–30.

    Article  PubMed  Google Scholar 

  90. Sah RP, Chari ST. Clinical hypothyroidism in autoimmune pancreatitis. Pancreas 39(7):1114–6.

  91. Sah RP, Pannala R, Zhang L, et al. Eosinophilia and allergic disorders in autoimmune pancreatitis. Am J Gastroenterol. 105(11):2485–91.

  92. Takahashi N, Kawashima A, Fletcher JG, et al. Renal involvement in patients with autoimmune pancreatitis: CT and MR imaging findings. Radiology. 2007;242(3):791–801.

    Article  PubMed  Google Scholar 

  93. Rudmik L, Trpkov K, Nash C, et al. Autoimmune pancreatitis associated with renal lesions mimicking metastatic tumours. CMAJ. 2006;175(4):367–9.

    Article  PubMed  Google Scholar 

  94. Cornell LD, Chicano SL, Deshpande V, et al. Pseudotumors due to IgG4 immune-complex tubulointerstitial nephritis associated with autoimmune pancreatocentric disease. Am J Surg Pathol. 2007;31(10):1586–97.

    Article  PubMed  Google Scholar 

  95. Watson SJ, Jenkins DA, Bellamy CO. Nephropathy in IgG4-related systemic disease. Am J Surg Pathol. 2006;30(11):1472–7.

    Article  PubMed  Google Scholar 

  96. Hamano H, Kawa S, Ochi Y, et al. Hydronephrosis associated with retroperitoneal fibrosis and sclerosing pancreatitis. Lancet. 2002;359(9315):1403–4.

    Article  PubMed  Google Scholar 

  97. Hirano K, Kawabe T, Komatsu Y, et al. High-rate pulmonary involvement in autoimmune pancreatitis. Intern Med J. 2006;36(1):58–61.

    Article  PubMed  CAS  Google Scholar 

  98. Chung H, Watanabe T, Kudo M, et al. Identification and characterization of IgG4-associated autoimmune hepatitis. Liver Int. 30(2):222–31.

  99. Umemura T, Zen Y, Hamano H, et al. Immunoglobin G4-hepatopathy: association of immunoglobin G4-bearing plasma cells in liver with autoimmune pancreatitis. Hepatology. 2007;46(2):463–71.

    Article  PubMed  CAS  Google Scholar 

  100. Uehara T, Hamano H, Kawakami M, et al. Autoimmune pancreatitis-associated prostatitis: distinct clinicopathological entity. Pathol Int. 2008;58(2):118–25.

    Article  PubMed  Google Scholar 

  101. Nayar M, Charnley R, Scott J, et al. Autoimmune pancreatitis with multiorgan involvement. A case of pericardial involvement. JOP. 2009;10(5):539–42.

    PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, MN, 55905, USA

    Raghuwansh P. Sah & Suresh T. Chari

  2. Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Suresh T. Chari

Authors
  1. Raghuwansh P. Sah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Suresh T. Chari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Suresh T. Chari.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sah, R.P., Chari, S.T. Autoimmune Pancreatitis: An Update on Classification, Diagnosis, Natural History and Management. Curr Gastroenterol Rep 14, 95–105 (2012). https://doi.org/10.1007/s11894-012-0246-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-012-0246-8

Keywords

Search

Navigation