Amendment of the Japanese Consensus Guidelines for Autoimmune Pancreatitis, 2013 III. Treatment and prognosis of autoimmune pancreatitis

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• 作者：Terumi Kamisawa (1)
  Kazuichi Okazaki (2)
  Shigeyuki Kawa (3)
  Tetsuhide Ito (4)
  Kazuo Inui (5)
  Hiroyuki Irie (6)
  Takayoshi Nishino (7)
  Kenji Notohara (8)
  Isao Nishimori (9)
  Shigeki Tanaka (10)
  Toshimasa Nishiyama (11)
  Koichi Suda (12)
  Keiko Shiratori (13)
  Masao Tanaka (14)
  Tooru Shimosegawa (15)
  
• 关键词：Autoimmune pancreatitis ; Guideline ; Treatment ; Steroid
• 刊名：Journal of Gastroenterology
• 出版年：2014
• 出版时间：June 2014
• 年：2014
• 卷：49
• 期：6
• 页码：961-970
• 全文大小：
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• 作者单位：Terumi Kamisawa (1)
  Kazuichi Okazaki (2)
  Shigeyuki Kawa (3)
  Tetsuhide Ito (4)
  Kazuo Inui (5)
  Hiroyuki Irie (6)
  Takayoshi Nishino (7)
  Kenji Notohara (8)
  Isao Nishimori (9)
  Shigeki Tanaka (10)
  Toshimasa Nishiyama (11)
  Koichi Suda (12)
  Keiko Shiratori (13)
  Masao Tanaka (14)
  Tooru Shimosegawa (15)
  
  1. Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
  2. Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
  3. Center for Health, Safety and Environmental Management, Shinshu University, Matsumoto, Japan
  4. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  5. Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Nagoya, Japan
  6. Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
  7. Department of Gastroenterology, Yachiyo Medical Center, Tokyo Women’s Medical University, Yachiyo, Japan
  8. Department of Anatomic Pathology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
  9. Nishimori Clinic, Kochi, Japan
  10. Department of Acupuncture and Moxibusion, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
  11. Department of Public Health and Hygiene, Kansai Medical University, Osaka, Japan
  12. Department of Pathology, Tokyo-West Tokushukai Hospital, Tokyo, Japan
  13. Department of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
  14. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  15. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
  
• ISSN：1435-5922

文摘

The standard treatment for autoimmune pancreatitis (AIP) is steroid therapy, although some patients improve spontaneously. Indications for steroid therapy in AIP patients are symptoms such as obstructive jaundice, abdominal pain, back pain, and the presence of symptomatic extrapancreatic lesions. Prior to steroid therapy, obstructive jaundice should be managed by biliary drainage, and blood glucose levels should be controlled in patients with diabetes mellitus. The recommended initial oral prednisolone dose for induction of remission is 0.6?mg/kg/day, which is administered for 2-?weeks. The dose is then tapered by 5?mg every 1-?weeks, based on changes in clinical manifestations, biochemical blood tests (such as liver enzymes and IgG or IgG4 levels), and repeated imaging findings (US, CT, MRCP, ERCP, etc.). The dose is tapered to a maintenance dose (2.5-?mg/day) over a period of 2-?months. Cessation of steroid therapy should be based on the disease activity in each case. Termination of maintenance therapy should be planned within 3?years in cases with radiological and serological improvement. Re-administration or dose-up of steroid is effective for treating AIP relapse. Application of immunomodulatory drugs is considered for AIP patients who prove resistant to steroid therapy. The prognosis of AIP appears to be good over the short-term with steroid therapy. The long-term outcome is less clear, as there are many unknown factors, such as relapse, pancreatic exocrine or endocrine dysfunction, and associated malignancy.