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Diagnosis, treatment and long-term outcome of autoimmune pancreatitis in Sweden.
Vujasinovic, Miroslav; Valente, Roberto; Maier, Pia; von Beckerath, Victoria; Haas, Stephan L; Arnelo, Urban; Del Chiaro, Marco; Kartalis, Nikolaos; Pozzi-Mucelli, Raffaella Maria; Fernandez-Moro, Carlos; Verbeke, Caroline Sophie; Yu, Jingru; Ye, Weimin; Löhr, J Matthias.
Afiliação
  • Vujasinovic M; Department for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
  • Valente R; Department for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; Department for Digestive Diseases, Sapienza University of Rome, Rome, Italy.
  • Maier P; Department for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
  • von Beckerath V; Department for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
  • Haas SL; Department for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
  • Arnelo U; Department for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
  • Del Chiaro M; Department for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
  • Kartalis N; Department of Abdominal Radiology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
  • Pozzi-Mucelli RM; Department of Abdominal Radiology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
  • Fernandez-Moro C; Department of Pathology, Karolinska University Hospital, Stockholm, Sweden.
  • Verbeke CS; Department of Pathology, Karolinska University Hospital, Stockholm, Sweden; Department of Pathology, University of Oslo, Oslo, Norway.
  • Yu J; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
  • Ye W; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
  • Löhr JM; Department for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden. Electronic address: matthias.lohr@ki.se.
Pancreatology ; 18(8): 900-904, 2018 Dec.
Article em En | MEDLINE | ID: mdl-30236651
INTRODUCTION: Autoimmune pancreatitis (AIP) is a pancreatic inflammatory process characterized by a strong inflammatory cell infiltration and two histopathologically distinct subtypes: type 1 and type 2. Diagnosis is often challenging and requires a combination of clinical, laboratory and imaging data. AIP can mimic pancreatic tumours leading to unnecessary resections if not correctly diagnosed. Short- and long-term outcomes of AIP have been poorly investigated so far and no large series have been previously reported from Sweden. METHODS: A single-centre, retrospective, cohort study of patients with histologically confirmed or highly probable diagnosis of AIP according to ICDC criteria. Demographic, clinical and radiological characteristics, type of treatment and its outcomes were collected and analysed. RESULTS: Seventy-one patients with AIP (87% with type 1), were evaluated at Karolinska University Hospital between 2004 and 2018; 49% males, mean age 49 years (range 44-53). Among them, 28% were histologically confirmed, 35% presented with jaundice, 22% with acute pancreatitis, 39% had non-specific symptoms such as weight loss or abdominal pain, 84% showed other organ involvement (OOI). Radiologically, 76% showed a focal pancreatic enlargement, 27% diffuse enlargement, 27% signs of acute pancreatitis and 10% of chronic pancreatitis. Overall, 58 patients (81%) underwent treatment with different medications: 46 (79%) cortisone, 7 (12%) azathioprine, 5 (8%) other immunosuppressive drugs. Twenty-six (36%) underwent biliary stenting and 12 (16%) were given surgery. In total, 47% of patients developed pancreatic exocrine insufficiency (PEI), of whom 76% had a severe form (faecal elastase-1 < 100 µg/g) and 21% of patients developed diabetes mellitus (pancreatic endocrine insufficiency), of whom 73% required insulin. CONCLUSIONS: AIP is a challenging disease for diagnosis and treatment. Cortisone treatment is generally successful and provides clinical remission in the large majority of patients (>90%). In the further course of the disease, a considerable number of patients develop PEI and diabetes. Only one-quarter of patients exhibit on imaging the characteristic "sausage-like" pancreas (diffuse enlargement), approximately three-quarters had a focal mass that could be misdiagnosed as pancreatic malignancy.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pancreatite / Doenças Autoimunes Tipo de estudo: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pancreatite / Doenças Autoimunes Tipo de estudo: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Ano de publicação: 2018 Tipo de documento: Article