Autoimmune pancreatitis complicated with inflammatory bowel disease and comparative study of type 1 and type 2 autoimmune pancreatitis

Type 2 autoimmune pancreatitis, an increasingly recognized etiology of pancreatitis in patients less than 20 years old, has characteristically been diagnosed with the histological finding of duct-centric pancreatitis in a patient who lacks elevated serum immunoglobulin G4. We present the case of a nonobese 15-year-old male, without any chronic medical conditions, who presented with the chief complaint of abdominal pain. The laboratory study results were remarkable for a lipase level of 5,419 U/L and a γ-glutamyl transferase level of 373 U/L. Magnetic resonance cholangiopancreatography revealed delayed contrast enhancement of the pancreas, diffuse parenchymal enlargement, and lack of normal lobulation. The patient’s serum immunoglobulin G4 level was found to be 66 mg/dL, which was within normal limits and supportive of a diagnosis of type 2 autoimmune pancreatitis. Despite the absence of intestinal complaints, the patient underwent subsequent endoscopy due to the correlation of type 2 autoimmune pancreatitis with inflammatory bowel disease that has been described in recent literature. Pan-colonic mild colitis was visualized, and the patient began treatment with steroids, to which he quickly responded. Performing endoscopy on this patient allowed for confident initiation of early therapy for both autoimmune pancreatitis and inflammatory bowel disease, and may have limited further surgical intervention and disease progression. For these reasons, this case highlights the utility of endoscopy in pediatric patients with suspected type 2 autoimmune pancreatitis, even in the absence of intestinal symptoms.

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Autoimmune Pancreatitis Type 2: Case Report

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709617734245 ◽

2017 ◽

Vol 5 (4) ◽

pp. 232470961773424 ◽

Cited By ~ 1

Author(s):

Chidinma Onweni ◽

Harika Balagoni ◽

Jennifer M. Treece ◽

Emmanuel Addo Yobo ◽

Archi Patel ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Acute Pancreatitis ◽

Case Report ◽

Autoimmune Pancreatitis ◽

Corticosteroid Treatment ◽

Unknown Etiology ◽

Inflammatory Bowel ◽

Igg4 Antibody

A middle-aged man presents with acute pancreatitis of unknown etiology and is found to have a presentation consistent with the diagnosis of type 2 autoimmune pancreatitis (AIP). AIP is a group of rare heterogeneous diseases that are challenging to diagnose. There are 2 types of AIP. Type 1 disease is the more common worldwide than type 2 AIP. While type 1 AIP is associated with IgG4-positive antibodies, type 2 AIP is IgG4 antibody negative. Both types of AIP are responsive to corticosteroid treatment. Although type 1 AIP has more extrapancreatic manifestations and more commonly relapses, this is a case of a patient with type 2 AIP with inflammatory bowel disease and relapsing course.

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Prevalence of inflammatory bowel disease in alcoholic, non-alcoholic and autoimmune pancreatitis

Zeitschrift für Gastroenterologie ◽

10.1055/s-0043-123881 ◽

2018 ◽

Vol 56 (05) ◽

pp. 469-478

Author(s):

Michael Hirth ◽

Christel Weiss ◽

Philip Weidner ◽

Christoph Antoni ◽

Anne Thomann ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

General Population ◽

Autoimmune Pancreatitis ◽

Bowel Disease ◽

Exact Test ◽

Fisher's Exact Test ◽

Binomial Proportion ◽

Fisher’S Exact Test ◽

Inflammatory Bowel

Abstract Objectives Patients with inflammatory bowel disease (IBD) frequently reveal features of pancreatic inflammation. However, the prevalence of IBD in patients with alcoholic pancreatitis (AP) and nonalcoholic pancreatitis (NAP) has not yet been determined, and the prevalence of IBD in patients with autoimmune pancreatitis (AiP) from Germany is unknown. Aims Thus, we aimed, first, to determine the prevalence of IBD in AP, NAP, and AiP from a tertiary center in Germany and, second, to characterize patients with AiP and IBD. Methods We performed a retrospective cross-sectional study to determine the prevalence of IBD in patients with different forms of pancreatitis presenting to our clinic. Results Compared to the general population and to a control group with viral hepatitis from our clinic, we observed the most significant increase of IBD in patients with AiP (n = 3/28; p < 0.0001 vs. general population, binomial proportion test; p = 0.0112 vs. hepatitis group, Fisher’s exact test), followed by a significant increase in subjects with NAP (n = 11/278; p < 0.0001 vs. general population, binomial proportion test; p = 0.0338 vs. hepatitis group, Fisher’s exact test). A review of previous studies on the prevalence of IBD among patients with AiP revealed a combined prevalence of 12 % (n = 43/355). Type 2 AiP is significantly more often associated with IBD than type 1 AiP (n = 28/48, 58 % vs. n = 7/129, 5 %; combined patient cohort, p < 10E − 12; Fisher’s exact test). Conclusions Immune-mediated mechanisms related to IBD may participate in the development of AiP, especially AiP type 2, and may also increase the risk for the development of other forms of pancreatic inflammation.

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Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history

Gut ◽

10.1136/gut.42.3.387 ◽

1998 ◽

Vol 42 (3) ◽

pp. 387-391 ◽

Cited By ~ 320

Author(s):

T R Orchard ◽

B P Wordsworth ◽

D P Jewell

Keyword(s):

Inflammatory Bowel Disease ◽

Natural History ◽

Bowel Disease ◽

Joint Involvement ◽

Persistent Symptoms ◽

Patient Interview ◽

Large Joint ◽

Inflammatory Bowel

Background—Peripheral arthropathy is a well-recognised complication of inflammatory bowel disease (IBD). Little is known of its natural history, but a variety of joint involvement has been described, from large joint pauciarticular arthropathy to a rheumatoid pattern polyarthropathy.Aims—To classify the peripheral arthropathies according to pattern of articular involvement, and study their natural history and clinical associations.Methods—The case notes of all patients attending the Oxford IBD clinic were reviewed, and information on general disease characteristics, extraintestinal features, and arthropathy extracted. This was confirmed by direct patient interview using questionnaires at routine follow up. Patients with recorded joint swelling or effusion were classified as type 1 (pauciarticular) if less than five joints were involved and type 2 (polyarticular) if five or more were involved. Patients without evidence of swelling were classified as arthralgia.Results—In total, 976 patients with ulcerative colitis (UC) and 483 with Crohn’s disease (CD) were reviewed. Type 1 occurred in 3.6% of patients with UC (83% acute and self-limiting) and in 6.0% of those with CD (79% self-limiting); 83% and 76%, respectively, were associated with relapsing IBD. Type 2 occurred in 2.5% of patients with UC and 4.0% of those with CD; 87% and 89%, respectively, caused persistent symptoms whereas only 29% and 42%, respectively, were associated with relapsing IBD.Conclusion—Enteropathic peripheral arthropathy without axial involvement can be subdivided into a pauciarticular, large joint arthropathy, and a bilateral symmetrical polyarthropathy, each being distinguished by its articular distribution and natural history.

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