Autoimmune pancreatitis

Diagnosis

Due to the similarities between its signs and symptoms and those of pancreatic cancer, autoimmune pancreatitis can be difficult to diagnose. On the other hand, a precise diagnosis is important. Cancer that has not been diagnosed may cause therapy to be postponed or not provided at all.

Those with AIP frequently have a generalized enlargement of the pancreas as well as having a present mass. Blood and imaging tests are required to pinpoint the diagnosis and establish the type of AIP you have.

Autoimmune pancreatitis cannot be diagnosed by a single test or distinguishing trait. Consensus diagnostic recommendations combine imaging, blood test, and biopsy results. Test may consists of the following:

• Imaging tests: CT, MRI, endoscopic ultrasound (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) are a few of the tests that can be performed on the pancreas and other organs. These examinations measure the size of the pancreas and look for evidence of scarring and duct narrowing.
• Blood tests: A test for high levels of IgG4, an immunoglobulin made by the immune system, will be performed on the patient. IgG4 levels in the blood will be extremely raised in those with type 1 AIP but not typically in those with type 2 AIP.

A positive test result does not imply that the patient has the condition. IgG4 levels in the blood are also elevated in a tiny percentage of those without autoimmune pancreatitis, including some with pancreatic cancer.

• Endoscopic core biopsy: A sample of pancreatic tissue is examined in the lab during this test by pathologists. A pathologist with experience can quickly identify AIP under a microscope due to its characteristic look. A health care provider will use an endoscope, a tiny tube that is inserted via the mouth into the stomach, to remove some pancreatic tissue under ultrasound guidance.

The difficulty lies in collecting a tissue sample that is big large enough to be examined, rather than just a few cells. Results may not be definitive because this treatment is not extensively used.

• Corticosteroid trial: Steroids typically work to treat autoimmune pancreatitis; occasionally, a trial course of this medication is prescribed to confirm a diagnosis. However, this approach should ideally only be employed with expert supervision, and only in cases where there is substantial evidence to establish an autoimmune pancreatitis diagnosis. CT and an improvement in serum IgG4 levels are used to gauge how well corticosteroids are working.

Treatment

Autoimmune pancreatitis occasionally resolves on its own in a few patients. However, the majority of patients require treatment.

• Steroids: These medications control an inflammatory response and a hyperactive immune system. After a brief course of prednisolone or prednisone, symptoms associated with autoimmune pancreatitis frequently exhibit improvement. In numerous cases, individuals respond promptly and may experience significant relief. Occasionally, individuals may even show signs of improvement without requiring any treatment.
• Biliary stenting: In patients with obstructive jaundice symptoms, a healthcare provider may occasionally place a tube to empty the bile ducts (biliary stenting). But frequently, steroid therapy is all that is needed to improve jaundice. If the diagnosis is questionable, drainage may be suggested. At the time of stent placement, tissue samples and cells from the bile duct may be collected.
• Immunosuppressants and immunomodulators: In type 1 AIP, disease relapse occurs in approximately 30% to 50% of cases, while in type 2 AIP, the relapse rate is less than 10%. These relapses often necessitate additional treatment, and in certain instances, long-term management may be required.

Healthcare providers often incorporate steroid-sparing medications, which can suppress or modify the immune system, into the treatment regimen to the course of therapy to assist lessen the severe adverse effects linked to prolonged steroid use. Depending on how the patient react to steroid-sparing therapy, they might be able to completely stop taking steroids.

Rituximab, azathioprine, mercaptopurine, and mycophenolate are immunosuppressants and immunomodulators. Long-term advantages are still being researched, but they have mostly been tested on small sample sizes.

• Observation of other organ involvement: Other organ involvement, such as swollen lymph nodes and salivary glands, bile duct scarring, liver inflammation, and renal illness are also linked to type 1 AIP. The healthcare provider will continue to monitor the patient even if these symptoms might become less severe or even go away entirely with steroid therapy.