Treating patients with autoimmune pancreatitis: Results from a long-term follow-up study

Background: Steroid therapy is currently common treatment for autoimmune pancreatitis (AIP); however, indications of steroid therapy have yet to be established, and the clinical course after steroid therapy is unknown. Methods: A total of 23 patients with AIP were subdivided into 4 groups according to the initial treatments undertaken. They were treated with pancreatoduodenectomy on suspicion of pancreatic tumor in 6 patients, choledo-choduodenostomy with pancreatic biopsy in 4 patients, supportive therapy in 3 patients, and steroid therapy in 10 patients. Clinical course of AIP in each group was examined. Results: Prognosis of the AIP patients is almost good except for the 2 patients who progressed to pancreatic insufficiency after resection. Two patients without jaundice improved spontaneously. Steroid therapy was effective in all patients treated, but pancreatic atrophy developed in 5 of these patients. Steroid therapy improved insulin secretion and glycemic control in 4 of 7 diabetes mellitus (DM) patients. Conclusion: To avoid futile surgery, in relatively elderly male patients with obstructive jaundice suggestive of pancreatic carcinoma, preoperative clinical suspicion of AIP is mandatory. Indications of steroid therapy for AIP are thought to be obstructive jaundice due to stenosis of the bile duct, other associated systemic autoimmune, and DM coincidental with AIP.