T. Ito et al., AUTOIMMUNE PANCREATITIS AS A NEW CLINICAL ENTITY - 3 CASES OF AUTOIMMUNE PANCREATITIS WITH EFFECTIVE STEROID-THERAPY, Digestive diseases and sciences, 42(7), 1997, pp. 1458-1468
The most common forms of chronic pancreatitis are related to alcohol i
ngestion, whereas the entity of non-alcohol-associated (idiopathic) pa
ncreatitis is poorly understood. Autoimmunity has been suggested as a
possible etiologic factor of idiopathic chronic pancreatitis. A total
of 362 Japanese patients underwent endoscopic retrograde pancreatograp
hy (ERP) for suspected pancreatic disease, and 161 were diagnosed with
chronic pancreatitis. Among them, we found three cases (1.86% inciden
ce) of unique chronic pancreatitis. in which ERP revealed diffuse narr
owing of the main pancreatic duct with an irregular wall. We diagnosed
these three patients as having pancreatitis associated with an autoim
mune mechanism morphologically and biochemically and started them on s
teroid therapy. The characteristics of the these three patients were a
s follows: hypergammaglobulinemia, eosinophilia, ultrasonography showi
ng hypoehoic diffuse swelling in the pancreas (sausage-like appearance
), ERP showing diffuse narrowing of the main pancreatic duct with irre
gular like thumbprint-like marks, reversible exocrine insufficiency, a
nd positive anti-carbonic anhydrase II antibody. After one month of th
e treatment with steroids, pancreatitis dramatically Improved morpholo
gically and enzymatically. Here we describe these cases of the suspect
ed autoimmune chronic pancreatitis. We must recognize the concept and
the features of autoimmune pancreatitis in order to avoid unnecessary
surgery as pancreatic cancer.