Clinical profiles and outcomes in idiopathic duct-centric chronic pancreatitis (type 2 autoimmune pancreatitis)

The Mayo Clinic experience

Phil A. Hart, Michael J. Levy, Thomas Christopher Smyrk, Naoki Takahashi, Barham K Abu Dayyeh, Jonathan E. Clain, Ferga C. Gleeson, Randall K. Pearson, Bret Thomas Petersen, Mark Topazian, Santhi Swaroop Vege, Lizhi Zhang, Suresh T Chari

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objective Idiopathic duct-centric chronic pancreatitis (IDCP), also known as type 2 autoimmune pancreatitis (AIP), is an uncommon subtype of AIP. International Consensus Diagnostic Criteria for IDCP propose that the diagnosis requires pancreatic histology and/or concurrent IBD. We examined our experience with IDCP (type 2 AIP) to assess the appropriateness of these criteria, and identify unique characteristics in patients presenting with acute pancreatitis. Design We reviewed the Mayo Clinic AIP database through May 2014 to identify subjects with either definitive (n=31) or probable (n=12) IDCP. We compared demographic and clinical factors based on strength of diagnostic confidence (definitive versus probable), presence of IBD, and acute pancreatitis as the presenting manifestation. Relapse-free survival was determined using the Kaplan-Meier method. Results The clinical profiles were similar irrespective of the diagnostic criteria fulfilled. Common clinical presentations included acute pancreatitis (n=25, 58.1%, 12 of whom (27.9%) had recurrent pancreatitis) and pancreatic mass/obstructive jaundice (n=15, 34.9%). The cumulative relapse rate was 10.6% at 3 years (median follow-up 2.9 years). Relapse-free survival was similar for the different diagnostic categories, but was decreased in those initially presenting with acute pancreatitis (p=0.047) or treated with steroids (vs surgery, p=0.049). Conclusions The current diagnostic classification of probable IDCP and the inclusion of IBD as a supportive criterion appear valid, because patients have similar clinical profiles and disease-related outcomes to those with definitive IDCP. Concurrent IBD, especially in young patients, may suggest when IDCP is the underlying cause of recurrent acute pancreatitis, but additional studies are needed for validation.

Original languageEnglish (US)
JournalGut
DOIs
StateAccepted/In press - Jun 17 2015

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Chronic Pancreatitis
Pancreatitis
Recurrence
Survival
Obstructive Jaundice
Validation Studies
Histology
Steroids
Demography
Databases

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Clinical profiles and outcomes in idiopathic duct-centric chronic pancreatitis (type 2 autoimmune pancreatitis) : The Mayo Clinic experience. / Hart, Phil A.; Levy, Michael J.; Smyrk, Thomas Christopher; Takahashi, Naoki; Dayyeh, Barham K Abu; Clain, Jonathan E.; Gleeson, Ferga C.; Pearson, Randall K.; Petersen, Bret Thomas; Topazian, Mark; Vege, Santhi Swaroop; Zhang, Lizhi; Chari, Suresh T.

In: Gut, 17.06.2015.

Research output: Contribution to journalArticle

Hart, Phil A. ; Levy, Michael J. ; Smyrk, Thomas Christopher ; Takahashi, Naoki ; Dayyeh, Barham K Abu ; Clain, Jonathan E. ; Gleeson, Ferga C. ; Pearson, Randall K. ; Petersen, Bret Thomas ; Topazian, Mark ; Vege, Santhi Swaroop ; Zhang, Lizhi ; Chari, Suresh T. / Clinical profiles and outcomes in idiopathic duct-centric chronic pancreatitis (type 2 autoimmune pancreatitis) : The Mayo Clinic experience. In: Gut. 2015.
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title = "Clinical profiles and outcomes in idiopathic duct-centric chronic pancreatitis (type 2 autoimmune pancreatitis): The Mayo Clinic experience",
abstract = "Objective Idiopathic duct-centric chronic pancreatitis (IDCP), also known as type 2 autoimmune pancreatitis (AIP), is an uncommon subtype of AIP. International Consensus Diagnostic Criteria for IDCP propose that the diagnosis requires pancreatic histology and/or concurrent IBD. We examined our experience with IDCP (type 2 AIP) to assess the appropriateness of these criteria, and identify unique characteristics in patients presenting with acute pancreatitis. Design We reviewed the Mayo Clinic AIP database through May 2014 to identify subjects with either definitive (n=31) or probable (n=12) IDCP. We compared demographic and clinical factors based on strength of diagnostic confidence (definitive versus probable), presence of IBD, and acute pancreatitis as the presenting manifestation. Relapse-free survival was determined using the Kaplan-Meier method. Results The clinical profiles were similar irrespective of the diagnostic criteria fulfilled. Common clinical presentations included acute pancreatitis (n=25, 58.1{\%}, 12 of whom (27.9{\%}) had recurrent pancreatitis) and pancreatic mass/obstructive jaundice (n=15, 34.9{\%}). The cumulative relapse rate was 10.6{\%} at 3 years (median follow-up 2.9 years). Relapse-free survival was similar for the different diagnostic categories, but was decreased in those initially presenting with acute pancreatitis (p=0.047) or treated with steroids (vs surgery, p=0.049). Conclusions The current diagnostic classification of probable IDCP and the inclusion of IBD as a supportive criterion appear valid, because patients have similar clinical profiles and disease-related outcomes to those with definitive IDCP. Concurrent IBD, especially in young patients, may suggest when IDCP is the underlying cause of recurrent acute pancreatitis, but additional studies are needed for validation.",
author = "Hart, {Phil A.} and Levy, {Michael J.} and Smyrk, {Thomas Christopher} and Naoki Takahashi and Dayyeh, {Barham K Abu} and Clain, {Jonathan E.} and Gleeson, {Ferga C.} and Pearson, {Randall K.} and Petersen, {Bret Thomas} and Mark Topazian and Vege, {Santhi Swaroop} and Lizhi Zhang and Chari, {Suresh T}",
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AU - Hart, Phil A.

AU - Levy, Michael J.

AU - Smyrk, Thomas Christopher

AU - Takahashi, Naoki

AU - Dayyeh, Barham K Abu

AU - Clain, Jonathan E.

AU - Gleeson, Ferga C.

AU - Pearson, Randall K.

AU - Petersen, Bret Thomas

AU - Topazian, Mark

AU - Vege, Santhi Swaroop

AU - Zhang, Lizhi

AU - Chari, Suresh T

PY - 2015/6/17

Y1 - 2015/6/17

N2 - Objective Idiopathic duct-centric chronic pancreatitis (IDCP), also known as type 2 autoimmune pancreatitis (AIP), is an uncommon subtype of AIP. International Consensus Diagnostic Criteria for IDCP propose that the diagnosis requires pancreatic histology and/or concurrent IBD. We examined our experience with IDCP (type 2 AIP) to assess the appropriateness of these criteria, and identify unique characteristics in patients presenting with acute pancreatitis. Design We reviewed the Mayo Clinic AIP database through May 2014 to identify subjects with either definitive (n=31) or probable (n=12) IDCP. We compared demographic and clinical factors based on strength of diagnostic confidence (definitive versus probable), presence of IBD, and acute pancreatitis as the presenting manifestation. Relapse-free survival was determined using the Kaplan-Meier method. Results The clinical profiles were similar irrespective of the diagnostic criteria fulfilled. Common clinical presentations included acute pancreatitis (n=25, 58.1%, 12 of whom (27.9%) had recurrent pancreatitis) and pancreatic mass/obstructive jaundice (n=15, 34.9%). The cumulative relapse rate was 10.6% at 3 years (median follow-up 2.9 years). Relapse-free survival was similar for the different diagnostic categories, but was decreased in those initially presenting with acute pancreatitis (p=0.047) or treated with steroids (vs surgery, p=0.049). Conclusions The current diagnostic classification of probable IDCP and the inclusion of IBD as a supportive criterion appear valid, because patients have similar clinical profiles and disease-related outcomes to those with definitive IDCP. Concurrent IBD, especially in young patients, may suggest when IDCP is the underlying cause of recurrent acute pancreatitis, but additional studies are needed for validation.

AB - Objective Idiopathic duct-centric chronic pancreatitis (IDCP), also known as type 2 autoimmune pancreatitis (AIP), is an uncommon subtype of AIP. International Consensus Diagnostic Criteria for IDCP propose that the diagnosis requires pancreatic histology and/or concurrent IBD. We examined our experience with IDCP (type 2 AIP) to assess the appropriateness of these criteria, and identify unique characteristics in patients presenting with acute pancreatitis. Design We reviewed the Mayo Clinic AIP database through May 2014 to identify subjects with either definitive (n=31) or probable (n=12) IDCP. We compared demographic and clinical factors based on strength of diagnostic confidence (definitive versus probable), presence of IBD, and acute pancreatitis as the presenting manifestation. Relapse-free survival was determined using the Kaplan-Meier method. Results The clinical profiles were similar irrespective of the diagnostic criteria fulfilled. Common clinical presentations included acute pancreatitis (n=25, 58.1%, 12 of whom (27.9%) had recurrent pancreatitis) and pancreatic mass/obstructive jaundice (n=15, 34.9%). The cumulative relapse rate was 10.6% at 3 years (median follow-up 2.9 years). Relapse-free survival was similar for the different diagnostic categories, but was decreased in those initially presenting with acute pancreatitis (p=0.047) or treated with steroids (vs surgery, p=0.049). Conclusions The current diagnostic classification of probable IDCP and the inclusion of IBD as a supportive criterion appear valid, because patients have similar clinical profiles and disease-related outcomes to those with definitive IDCP. Concurrent IBD, especially in young patients, may suggest when IDCP is the underlying cause of recurrent acute pancreatitis, but additional studies are needed for validation.

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