Document Detail

Appropriate steroid therapy for autoimmune pancreatitis based on long-term outcome.
MedLine Citation:
PMID:  18415756     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Because autoimmune pancreatitis (AIP) responds well to corticosteroids, many AIP patients are given this treatment. However, there is no consensus on the indications, dose, or duration of steroid treatment. The aim of this study was to establish the most appropriate steroid therapy regimen. MATERIAL AND METHODS: We retrospectively reviewed morphological and serological improvement after steroid therapy and long-term outcome including relapse in 41 AIP patients who were given steroid therapy and were prospectively followed-up for more than 1 year. RESULTS: All patients responded to steroid therapy, which was given because of bile duct stenosis secondary to sclerosing cholangitis in 34 AIP patients. Pancreatic enlargement normalized within one month; however, 13 patients had incomplete resolution of pancreatic duct narrowing, and 14 patients had incomplete resolution of bile duct stenosis. There was no correlation between the degree of morphological improvement and the initial prednisolone dose (30 mg and 40 mg/day). In 58% of 19 patients, serum IgG4 elevation failed to normalize. Glucose intolerance improved in 38% of the 21 patients with diabetes mellitus. Nine patients who had complete morphological and serological resolution, stopped their medication, and none have relapsed. Thirty-two patients continued maintenance therapy, and 4 of these patients suffered relapse. CONCLUSIONS: The indications for steroid therapy in AIP patients include bile duct stenosis caused by sclerosing cholangitis and other systemic diseases, such as retroperitoneal fibrosis and diabetes mellitus. We recommend that oral prednisolone be used at an initial dose of 30 mg/day; maintenance therapy is required in cases without complete morphological and serological resolution.
Terumi Kamisawa; Atsutake Okamoto; Tokio Wakabayashi; Hiroyuki Watanabe; Norio Sawabu
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Scandinavian journal of gastroenterology     Volume:  43     ISSN:  1502-7708     ISO Abbreviation:  Scand. J. Gastroenterol.     Publication Date:  2008  
Date Detail:
Created Date:  2008-04-16     Completed Date:  2008-06-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0060105     Medline TA:  Scand J Gastroenterol     Country:  Norway    
Other Details:
Languages:  eng     Pagination:  609-13     Citation Subset:  IM    
Department of Internal Medicine and Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
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MeSH Terms
Aged, 80 and over
Autoimmune Diseases / drug therapy*,  immunology,  pathology
Cholestasis / complications,  drug therapy,  physiopathology
Constriction, Pathologic / complications
Glucocorticoids / therapeutic use*
Immunoglobulin G / blood
Middle Aged
Pancreatic Ducts / pathology
Pancreatitis / drug therapy*,  immunology,  pathology
Prednisolone / therapeutic use*
Reg. No./Substance:
0/Glucocorticoids; 0/Immunoglobulin G; 50-24-8/Prednisolone

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