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Diagnostic and therapeutic considerations in biopsy‐proven type 2 autoimmune pancreatitis: comparative analysis with biopsy‐proven type 1 autoimmune pancreatitis
Author(s) -
Pattabathula Krishna,
Waters Peadar S.,
Hwang Jason,
Bettington Mark,
Singh Mahendra,
Bryant Richard D.,
Cavallucci David J.,
O'Rourke Nicholas
Publication year - 2021
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.16445
Subject(s) - medicine , autoimmune pancreatitis , pancreatitis , biopsy , gastroenterology , autoimmune disease , retrospective cohort study , acute pancreatitis , disease
Background Autoimmune processes are now an increasingly recognized cause of acute and chronic pancreatitis. Autoimmune pancreatitis is a rare, benign pathology with two distinct clinicopathologic subtypes. The aim of this study was to compare the presentation, diagnostic considerations and outcomes of patients with biopsy‐proven type 1 and 2 autoimmune pancreatitis (AIP). Methods A retrospective review of the Queensland Health pathology database of histologically proven AIP was conducted. Parameters compared included demographics, diagnostic criterion and post‐treatment outcomes. Results Twenty‐three patients had a confirmed histological diagnosis of AIP (type 1 = 13, type 2 = 10). Patients with type 2 AIP were younger (median age 49 versus 59 years, P < 0.05). There was no significant difference in gender distribution of disease at presentation. Type 2 AIP presented with significant increased focal pancreatic changes on cross‐sectional imaging (80% versus 54%, P < 0.05). Serum IgG4 levels were raised (>1.40 g/L) in 69% of patients with type 1 AIP and not detected in type 2 ( P < 0.01). Concurrent underlying inflammatory bowel disease was present in a higher proportion of type 2 AIP (40% versus 15%, P < 0.05). A significantly increased proportion of patients with type 2 AIP underwent surgical resection (70% versus 30%, P < 0.05). Conservative management was utilized in more patients with type 1 disease (54% versus 30%). On follow‐up, two patients have experienced symptomatic relapse at 6–18 months. Conclusions Diagnostic challenges do exist and clinicians must suspect 2 type AIP in young, serum IgG4‐negative inflammatory bowel disease patients with recurrent pancreatitis.