Corticosteroids prevent the progression of autoimmune pancreatitis to chronic pancreatitis |
| |
| Affiliation: | 1. Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan;2. Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan;3. Department of Internal Medicine, Matsumoto Dental University, Shiojiri, Nagano, Japan;1. Department of Gastroenterology and Hepatology, Saint Peter’s University Hospital, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, USA;2. Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA;3. Department of Clinical Biochemistry and Immunology, Mayo Clinic, Rochester, MN, USA;4. Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, USA;1. Department of Anatomic Pathology, Kurashiki Central Hospital, Kurashiki, Japan;2. Tokyo Metropolitan Komagome Hospital, Tokyo, Japan;3. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan;4. Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan;5. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan;6. Department of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan;7. Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan;8. Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan;9. Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan;10. Department of Clinical Laboratory Science, Kanazawa University, Kanazawa, Japan;11. Department of Gastroenterology, Tokyo Women’s Medical University, Yachiyo Medical Center, Chiba, Japan;12. Department of Endoscopy, Yokohama City University Hospital, Yokohama, Japan;13. Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan;14. Department of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Japan;15. Department of Internal Medicine, Matsumoto Dental University, Shiojiri, Japan;1. Section of Gastroenterology, Biomedical Department of Internal and Specialized Medicine, University of Palermo, Palermo, Italy;3. Endoscopy Service, Department of Diagnostic and Therapeutic Services, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione (Mediterranean Institute for Transplantation and Highly Specialized Therapies), Palermo, Italy;4. PancreatoBiliary Endoscopy and Endoscopic Ultrasonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute (Istituto di Ricovero e Cura a Carattere Scientifico), Vita Salute San Raffaele University, Milan, Italy;6. Department of Medicine, Pancreas Institute, University of Verona, Verona, Italy;1. Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan;2. Division of Gastroenterology and Hepatology, Kochi Medical School, Kochi University, Kohasu Oko-cho, Nankoku, Kochi, 783-8505, Japan;3. Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis, 451 Health Sciences Drive Suite 6510, Davis, CA, 95616, USA;1. Departement of Hepato-Gastroenterology, Hôpital Cochin, AP-HP, Paris, France;3. Departement of Hepato-Gastroenterology, Hôpital Beaujon, AP-HP, Clichy La Garenne, France;4. Departement of Hepato-Gastroenterology, Hôpital Saint Louis, AP-HP, Paris, France;6. Departement of Hepato-Gastroenterology, Hôpital Saint Antoine, AP-HP, Paris, France;5. Departement of Hepato-Gastroenterology, Hôpital Nord, AP-HM, Marseille, France;7. Departement of Hepato-Gastroenterology, Hôpital Henri Mondor, AP-HP, Créteil, France;12. Departement of Hepato-Gastroenterology, Hôpital Haut-Lévêque, Pessac, France;8. Departement of Hepato-Gastroenterology, CHU Nantes, Nantes, France;10. Departement of Hepato-Gastroenterology, Hôpital Louis Mourier, AP-HP, Colombes, France;9. Departement of Hepato-Gastroenterology, CH d’Aulnay, Aulnay sous-bois, France;71. Departement of Hepato-Gastroenterology, CHU Liège, Liège, Belgium;123. Departement of Hepato-Gastroenterology, CHU du Kremlin Bicêtre, AP-HP, Kremlin Bicêtre, France;84. Departement of Hepato-Gastroenterology, CHU Caen, Caen, France;106. Departement of Hepato-Gastroenterology, CH Gonesse, Gonesse, France;95. Departement of Hepato-Gastroenterology, CHU Rennes, Rennes, France;77. Departement of Hepato-Gastroenterology, Hôpital Bichat AP-HP, Paris, France;1212. Departement of Hepato-Gastroenterology, CHU Montpellier, Montpellier, France;88. Departement of Hepato-Gastroenterology, CH Montfermeil, Montfermeil, France |
| |
| Abstract: | Background/objectivesPatients with autoimmune pancreatitis (AIP) sometimes progress to chronic pancreatitis (CP). We evaluated the ability of corticosteroids to prevent the progression to CP.MethodsWe defined patients with definitive findings of CP (stones in the main pancreatic duct [MPD] or multiple pancreatic calcifications) as having severe calcification (SC). A total of 145 AIP patients were enrolled. We measured the duration between AIP diagnosis and SC development and retrospectively compared the time to SC development between patients with and without steroids. Multivariate analysis for factors associated with SC were performed.ResultsNineteen (13%) patients progressed to SC. Since 95 patients had pancreatic head swelling and SC was found in these patients only, our analysis focused mainly on these at-risk populations. In Kaplan-Meier analysis limited to patients with pancreatic head swelling, the incidence of SC was significantly lower in patients with steroids than in those without (hazard ratio [HR] 0.18, 95% confidence interval [CI] 0.07–0.52; p < 0.001). Multivariate testing of patients with pancreatic head swelling confirmed that steroid therapy was significantly associated with a lower incidence of SC (HR 0.11, 95% CI 0.03–0.34; p < 0.001), while MPD dilation at AIP diagnosis was related to a higher incidence of SC (HR 4.02, 95% CI 1.43–11.7; p = 0.009).ConclusionsCorticosteroids appeared to prevent progression to CP in AIP patients, especially in those with pancreatic head swelling. Patients with both pancreatic head swelling and MPD dilation at diagnosis have a higher incidence of progression to CP. Steroid therapy is suggested for these high-risk cases. |
| |
| Keywords: | Autoimmune pancreatitis Chronic pancreatitis Pancreatic calcification Steroid therapy |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
