GASTROENTEROLOGY ARTICLE OF THE WEEK
October 21, 2004
Kim K, Kim MH, Song MH, et al. Autoimmune chronic pancreatitis. Am J Gastroenterol 2004;99:1605-16.
1. Features of autoimmune chronic pancreatitis (AIP) include
a. hypergammaglobulinemia
b. favorable response to steroid therapy
c. more common in females
d. coexistence of other autoimmune diseases
e. painless pancreatic insufficiency
f. lymphoplasmacytic infiltration of the pancreatic tissue
g. affects mainly young (<30 years) adults
True or False
2. Painless jaundice is not a typical presenting feature for AIP.
3. AIP usually presents with discreet severe attacks of abdominal pain and marked elevation of amylase and lipase.
4. Elevated levels of IgG, specifically IgG4 subclass is present in the majority of cases.
5. AIP may present as a pancreatic head mass or as a diffusely enlarged pancreas on CT.
6. The hallmark finding of AIP on ERCP is diffuse or segmental irregular narrowing of the main pancreatic duct.
7. ERCP is more sensitive than MRCP in detecting the ductular changes caused by AIP.
8. Treatment with corticosteroid may resolve or improve the CT findings of diffuse pancreatic enlargement; changes are noticeable within 4 weeks.
9. Proposed criteria for the diagnosis of AIP include
a. Abnormal pancreatogram
b. Normal cholangiogram
c. Multiple pancreatic stones
d. Diffuse enlargement of the pancreas
e. Elevated levels of serum IgG or presence of autoimmune markers
f. Fibrotic changes with lymphocytoplamacytic infiltration of the pancreas on biopsy.