Vnitr Lek 2015, 61(2):114-118

Autoimmune pancreatitis - diagnostic consensus

Petr Dítě^1,*, Ivo Novotný², Bohuslav Kianička³, Martin Rydlo¹, Hana Nechutová³, Arnošt Martínek¹, Magdalena Uvírová⁴, Martina Bojková¹, Jana Dvořáčková⁵

¹ Akademické centrum gastroenterologie Interní kliniky LF Ostravské univerzity a FN Ostrava, přednosta doc. MUDr. Arnošt Martínek, CSc.

² Gastroenterologické oddělení MOÚ Brno, vedoucí pracoviště MUDr. Milana Šachlová, CSc. et Ph.D.

³ Gastroenteroloígické oddělení II. interní kliniky LF MU a FN u sv. Anny Brno, přednosta prof. MUDr. Miroslav Souček, CSc.

⁴ Vědecký a výzkumný institut Agel, pobočka Ostrava-Vítkovice, CGB laboratoř, ředitelka společnosti RNDr. Magdalena Uvírová

⁵ Ústav patologie LF OU a FN Ostrava, vedoucí ústavu doc. MUDr. Jaroslav Horáček, CSc.

The autoimmune type of pancreatitis represents the specific disease of pancreas, with significant contribution of autoimmune processes in its etiopathogenesis. Currently, there are two proved subtypes of this particular pancreatopathy, which are defined clinically, histomorphologically and serologically. They have many histomorphological signs in common, but differ in the presence of so-called granulocytic epithelial lesions (GEL), which are absent in subtype 1. The subtype 1 is characterized by the presence of gammaglobulines, esp. immunoglobuline G4 and IgG4 positive extrapancreatic lesions. The subtype 2 is typically associated with the inflammatory bowel diseases, esp. ulcerative colitis. But the common characteristic of both subtypes is the fact response to applied steroid treatment. Due to diverse diagnostic criteria in the past, in 2011 the consensus for the diagnosis of autoimmune pancreatitis was announced. It is based on clinical symptoms, biochemical results, the results got by using of imaging methods, histomorphology and positive response to steroid treatment. The matter to be solved is the question of early differential diagnosis between focal autoimmune pancreatitis and adenocarcinoma of pancreatic head. From imaging methods are MRI/CT, MRCP (in Asia ERCP), EUS with targeted biopsy of the gland (under EUS control), are recommended as the methods of choice.

Keywords: autoimmune pancreatitis; CT, MRI; endoscopic retrograde cholangio-pancreatography; granulocytic endothelial lesion (GEL); immunoglobulin G4; MRCP; steroids

Received: September 5, 2014; Accepted: November 25, 2014; Published: February 1, 2015  Show citation