AUTOIMMUNE PANCREATITIS AS A NEW CLINICAL ENTITY - 3 CASES OF AUTOIMMUNE PANCREATITIS WITH EFFECTIVE STEROID-THERAPY

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.