| Theme |
A Trend in the Practice of Pancreatitis |
| Title |
Current and Future Issues for Clinical Diagnostic Criteria Concerning Autoimmune Pancreatitis |
| Author |
Kazuichi Okazaki |
Department of Gastroenterology and Hepatology, Kansai Medical University |
| Author |
Masanori Koyabu |
Department of Gastroenterology and Hepatology, Kansai Medical University |
| Author |
Norimasa Fukata |
Department of Gastroenterology and Hepatology, Kansai Medical University |
| Author |
Daisaku Hachimine |
Department of Gastroenterology and Hepatology, Kansai Medical University |
| Author |
Hideaki Miyoshi |
Department of Gastroenterology and Hepatology, Kansai Medical University |
| Author |
Kazushige Uchida |
Department of Gastroenterology and Hepatology, Kansai Medical University |
| [ Summary ] |
We compared Japanese clinical diagnostic criteria 2006 with those in Korea and the United States and discussed current and future issues concerning diagnosis of autoimmune pancreatitis (AIP). The concept behind Japanese criteria is to have ones for practical use in differentiating AIP from pancreatic or biliary malignancy. However, not useful for differentiation of systemic disorders. Therefore, the criteria may be used for the minimum consensus concerning AIP but not for screening AIP. For pancreatic imaging, typical pancreatograms with CT or MRI are required in the Japanese and Korean criteria, but not in Mayo Clinic's. ERCP is mandatory in the Japanese, but MRCP is optional in Korea and the Mayo Clinic. In blood tests, the presence of autoantibodies in addition to high serum IgG4 levels, is part of the criteria for Korea and Japan, but not for the Mayo Clinic. Irrespective of laboratory or radiological data, only LPSP provides definitive information for diagnosis of AlP according to the Mayo Clinic's criteria. However, this not so in Japan or Korea. In the Mayo and Korean criteria, dense infiltration of IgG4 positive plasma cells into pancreatic specimens is useful for diagnosis when LPSP has not been confirmed. Extra-pancreatic lesions are included in the Korean and Mayo criteria but not in the Japanese. Steroid trials for the pancreas and / or extra-pancreatic lesions are available in the Korean and Mayo systems, but do not meet the Japanese criteria. However, pancreatic malignancy may accompany AIP. Although steroid trials may increase diagnostic sensitivity for AIP, the efficacy of steroids should be carefully evaluated. The therapeutic diagnoses available overseas are not recommended in Japan at this time. |