Autoimmune pancreatitis medical therapy: Difference between revisions

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{{Autoimmune pancreatitis}}
{{Autoimmune pancreatitis}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}}{{IQ}}


==Overview==
==Overview==
[[Glucocorticoids]] are found to play an important role in the management of autoimmune pancreatitis via several ways such as efficacy in alleviating symptoms, decreasing the size of the [[pancreas]], reversing histopathologic features in patients with AIP,  and mprovement of lab findings. About 2/3rd of patients show good response to [[glucocorticoids]] with complete recovery, 25% may require a second course of [[glucocorticoids]], and a few patients with autoimmune pancreatitis may require continuous treatment. [[Immunomodulatory]] drugs such as [[azathioprine]] are usually used when, AIP patients have no response to [[steroid]] management, [[relapse]] occurs and patients cannot be weaned off [[steroids]].


==Medical Therapy==
==Medical Therapy==
*Glucocorticoids are found to play an important role in the management of autoimmune pancreatitis via several ways such as:
**Efficacy in alleviating symptoms
**Decreasing the size of the pancreas
**Reversing histopathologic features in patients with AIP
===Disease Name===


* '''1 Stage 1 - Name of stage'''
=== Role of Glucocorticoids: ===
** 1.1 '''Specific Organ system involved 1'''
* Preferred regimen: [[Prednisone]] is usually administered at an initial dose of 40 mg/d for 4 weeks followed by a taper of the daily dosage by 5 mg/wk depending upon the clinical parameters.
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)


* 2 '''Stage 2 - Name of stage'''
*[[Glucocorticoids]] are found to play an important role in the management of autoimmune pancreatitis via several ways such as:<ref name="pmid14687819">{{cite journal |vauthors=Kamisawa T, Egawa N, Nakajima H, Tsuruta K, Okamoto A, Kamata N |title=Clinical difficulties in the differentiation of autoimmune pancreatitis and pancreatic carcinoma |journal=Am. J. Gastroenterol. |volume=98 |issue=12 |pages=2694–9 |year=2003 |pmid=14687819 |doi=10.1111/j.1572-0241.2003.08775.x |url=}}</ref><ref name="pmid17525092">{{cite journal |vauthors=Hirano K, Tada M, Isayama H, Yagioka H, Sasaki T, Kogure H, Nakai Y, Sasahira N, Tsujino T, Yoshida H, Kawabe T, Omata M |title=Long-term prognosis of autoimmune pancreatitis with and without corticosteroid treatment |journal=Gut |volume=56 |issue=12 |pages=1719–24 |year=2007 |pmid=17525092 |pmc=2095691 |doi=10.1136/gut.2006.115246 |url=}}</ref><ref name="pmid18583399">{{cite journal |vauthors=Moon SH, Kim MH, Park DH, Hwang CY, Park SJ, Lee SS, Seo DW, Lee SK |title=Is a 2-week steroid trial after initial negative investigation for malignancy useful in differentiating autoimmune pancreatitis from pancreatic cancer? A prospective outcome study |journal=Gut |volume=57 |issue=12 |pages=1704–12 |year=2008 |pmid=18583399 |doi=10.1136/gut.2008.150979 |url=}}</ref><ref name="pmid9246047">{{cite journal |vauthors=Ito T, Nakano I, Koyanagi S, Miyahara T, Migita Y, Ogoshi K, Sakai H, Matsunaga S, Yasuda O, Sumii T, Nawata H |title=Autoimmune pancreatitis as a new clinical entity. Three cases of autoimmune pancreatitis with effective steroid therapy |journal=Dig. Dis. Sci. |volume=42 |issue=7 |pages=1458–68 |year=1997 |pmid=9246047 |doi= |url=}}</ref>
** 2.1 '''Specific Organ system involved 1 '''
**Efficacy in alleviating symptoms.
**: '''Note (1):'''
**Decreasing the size of the pancreas.
**: '''Note (2)''':
**Reversing histopathologic features in patients with AIP.
**: '''Note (3):'''
**Improvement of lab findings such as:<ref name="pmid11236777">{{cite journal |vauthors=Hamano H, Kawa S, Horiuchi A, Unno H, Furuya N, Akamatsu T, Fukushima M, Nikaido T, Nakayama K, Usuda N, Kiyosawa K |title=High serum IgG4 concentrations in patients with sclerosing pancreatitis |journal=N. Engl. J. Med. |volume=344 |issue=10 |pages=732–8 |year=2001 |pmid=11236777 |doi=10.1056/NEJM200103083441005 |url=}}</ref>
*** 2.1.1 '''Adult'''
***Resolution of [[hypergammaglobulinemia]].
**** Parenteral regimen
***[[Autoantibodies]] become undetectable.
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
 
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
===== Response to Glucocorticoids: =====
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
* About 2/3rd of patients show good response to [[glucocorticoids]] with complete recovery.<ref name="pmid18222442">{{cite journal |vauthors=Ghazale A, Chari ST, Zhang L, Smyrk TC, Takahashi N, Levy MJ, Topazian MD, Clain JE, Pearson RK, Petersen BT, Vege SS, Lindor K, Farnell MB |title=Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy |journal=Gastroenterology |volume=134 |issue=3 |pages=706–15 |year=2008 |pmid=18222442 |doi=10.1053/j.gastro.2007.12.009 |url=}}</ref><ref name="pmid19532132">{{cite journal |vauthors=Raina A, Yadav D, Krasinskas AM, McGrath KM, Khalid A, Sanders M, Whitcomb DC, Slivka A |title=Evaluation and management of autoimmune pancreatitis: experience at a large US center |journal=Am. J. Gastroenterol. |volume=104 |issue=9 |pages=2295–306 |year=2009 |pmid=19532132 |doi=10.1038/ajg.2009.325 |url=}}</ref><ref name="pmid19345283">{{cite journal |vauthors=Sandanayake NS, Church NI, Chapman MH, Johnson GJ, Dhar DK, Amin Z, Deheragoda MG, Novelli M, Winstanley A, Rodriguez-Justo M, Hatfield AR, Pereira SP, Webster GJ |title=Presentation and management of post-treatment relapse in autoimmune pancreatitis/immunoglobulin G4-associated cholangitis |journal=Clin. Gastroenterol. Hepatol. |volume=7 |issue=10 |pages=1089–96 |year=2009 |pmid=19345283 |doi=10.1016/j.cgh.2009.03.021 |url=}}</ref>
**** Oral regimen
* Approximately 25% may require a second course of [[glucocorticoids]].
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
* A few patients with autoimmune pancreatitis may require continuous treatment.
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
 
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
==== Response to Glucocorticoids in patients with Biliary strictures: ====
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
Patients with biliary strictures have a variable response to [[glucocorticoids]] such as:<ref name="pmid18222442">{{cite journal |vauthors=Ghazale A, Chari ST, Zhang L, Smyrk TC, Takahashi N, Levy MJ, Topazian MD, Clain JE, Pearson RK, Petersen BT, Vege SS, Lindor K, Farnell MB |title=Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy |journal=Gastroenterology |volume=134 |issue=3 |pages=706–15 |year=2008 |pmid=18222442 |doi=10.1053/j.gastro.2007.12.009 |url=}}</ref><ref name="pmid19345283">{{cite journal |vauthors=Sandanayake NS, Church NI, Chapman MH, Johnson GJ, Dhar DK, Amin Z, Deheragoda MG, Novelli M, Winstanley A, Rodriguez-Justo M, Hatfield AR, Pereira SP, Webster GJ |title=Presentation and management of post-treatment relapse in autoimmune pancreatitis/immunoglobulin G4-associated cholangitis |journal=Clin. Gastroenterol. Hepatol. |volume=7 |issue=10 |pages=1089–96 |year=2009 |pmid=19345283 |doi=10.1016/j.cgh.2009.03.021 |url=}}</ref><ref name="pmid16843735">{{cite journal |vauthors=Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, Zhang L, Clain JE, Pearson RK, Petersen BT, Vege SS, Farnell MB |title=Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience |journal=Clin. Gastroenterol. Hepatol. |volume=4 |issue=8 |pages=1010–6; quiz 934 |year=2006 |pmid=16843735 |doi=10.1016/j.cgh.2006.05.017 |url=}}</ref><ref name="pmid15545176">{{cite journal |vauthors=Kamisawa T, Egawa N, Nakajima H, Tsuruta K, Okamoto A |title=Morphological changes after steroid therapy in autoimmune pancreatitis |journal=Scand. J. Gastroenterol. |volume=39 |issue=11 |pages=1154–8 |year=2004 |pmid=15545176 |doi=10.1080/00365520410008033 |url=}}</ref><ref name="pmid15632697">{{cite journal |vauthors=Wakabayashi T, Kawaura Y, Satomura Y, Watanabe H, Motoo Y, Sawabu N |title=Long-term prognosis of duct-narrowing chronic pancreatitis: strategy for steroid treatment |journal=Pancreas |volume=30 |issue=1 |pages=31–9 |year=2005 |pmid=15632697 |doi= |url=}}</ref>
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
* Patients with biliary strictures may respond to [[glucocorticoids]].
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
* Patients with biliary strictures may not respond to [[glucocorticoids]].
*** 2.1.2 '''Pediatric'''
* Patients with biliary strictures may have an incomplete response to [[glucocorticoids]].
**** Parenteral regimen
* Patients with biliary strictures may require maintenance therapy with [[glucocorticoids]] to prevent relapse.
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
* Patients with biliary strictures may require maintenance therapy with [[glucocorticoids]] and/or [[immunomodulatory]] drugs  to prevent [[relapse]].
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
====== Monitoring of clinical parameters in patients on glucocorticoid therapy: ======
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
[[Glucocorticoids]] are tapered depending upon following clinical parameters:<ref name="pmid17525092">{{cite journal |vauthors=Hirano K, Tada M, Isayama H, Yagioka H, Sasaki T, Kogure H, Nakai Y, Sasahira N, Tsujino T, Yoshida H, Kawabe T, Omata M |title=Long-term prognosis of autoimmune pancreatitis with and without corticosteroid treatment |journal=Gut |volume=56 |issue=12 |pages=1719–24 |year=2007 |pmid=17525092 |pmc=2095691 |doi=10.1136/gut.2006.115246 |url=}}</ref><ref name="pmid18583399">{{cite journal |vauthors=Moon SH, Kim MH, Park DH, Hwang CY, Park SJ, Lee SS, Seo DW, Lee SK |title=Is a 2-week steroid trial after initial negative investigation for malignancy useful in differentiating autoimmune pancreatitis from pancreatic cancer? A prospective outcome study |journal=Gut |volume=57 |issue=12 |pages=1704–12 |year=2008 |pmid=18583399 |doi=10.1136/gut.2008.150979 |url=}}</ref><ref name="pmid20736934">{{cite journal |vauthors=Maire F, Le Baleur Y, Rebours V, Vullierme MP, Couvelard A, Voitot H, Sauvanet A, Hentic O, Lévy P, Ruszniewski P, Hammel P |title=Outcome of patients with type 1 or 2 autoimmune pancreatitis |journal=Am. J. Gastroenterol. |volume=106 |issue=1 |pages=151–6 |year=2011 |pmid=20736934 |doi=10.1038/ajg.2010.314 |url=}}</ref><ref name="pmid19017924">{{cite journal |vauthors=Sahani DV, Sainani NI, Deshpande V, Shaikh MS, Frinkelberg DL, Fernandez-del Castillo C |title=Autoimmune pancreatitis: disease evolution, staging, response assessment, and CT features that predict response to corticosteroid therapy |journal=Radiology |volume=250 |issue=1 |pages=118–29 |year=2009 |pmid=19017924 |doi=10.1148/radiol.2493080279 |url=}}</ref>
**** Oral regimen
* Relief of symptoms.
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
* Serial changes in abdominal imaging of the pancreas and bile ducts.
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
* Decreased serum γ-globulin and IgG4 levels.
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
* Improvements in liver function tests.
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
=== Role of Immunomodulatory drugs: ===
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
[[Immunomodulatory]] drugs such as [[azathioprine]] are usually used when:
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
* AIP patients have no response to [[steroid]] management.
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
* AIP patients relapse, if [[steroids]] are discontinued.
**: '''Note (1):'''
* AIP patients cannot be weaned off [[steroids]].
**: '''Note (2)''':
The [[monoclonal antibody]], [[Rituximab]], is found to be effective in the management of AIP but further studies are required for the recommendation of routine use.<ref name="pmid22936672">{{cite journal |vauthors=Hart PA, Topazian MD, Witzig TE, Clain JE, Gleeson FC, Klebig RR, Levy MJ, Pearson RK, Petersen BT, Smyrk TC, Sugumar A, Takahashi N, Vege SS, Chari ST |title=Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab: the Mayo Clinic experience |journal=Gut |volume=62 |issue=11 |pages=1607–15 |year=2013 |pmid=22936672 |doi=10.1136/gutjnl-2012-302886 |url=}}</ref><ref name="pmid18328441">{{cite journal |vauthors=Topazian M, Witzig TE, Smyrk TC, Pulido JS, Levy MJ, Kamath PS, Chari ST |title=Rituximab therapy for refractory biliary strictures in immunoglobulin G4-associated cholangitis |journal=Clin. Gastroenterol. Hepatol. |volume=6 |issue=3 |pages=364–6 |year=2008 |pmid=18328441 |doi=10.1016/j.cgh.2007.12.020 |url=}}</ref><ref name="pmid19137434">{{cite journal |vauthors=Rueda JC, Duarte-Rey C, Casas N |title=Successful treatment of relapsing autoimmune pancreatitis in primary Sjögren's syndrome with rituximab: report of a case and review of the literature |journal=Rheumatol. Int. |volume=29 |issue=12 |pages=1481–5 |year=2009 |pmid=19137434 |doi=10.1007/s00296-009-0843-5 |url=}}</ref>
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Latest revision as of 15:32, 19 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Overview

Glucocorticoids are found to play an important role in the management of autoimmune pancreatitis via several ways such as efficacy in alleviating symptoms, decreasing the size of the pancreas, reversing histopathologic features in patients with AIP, and mprovement of lab findings. About 2/3rd of patients show good response to glucocorticoids with complete recovery, 25% may require a second course of glucocorticoids, and a few patients with autoimmune pancreatitis may require continuous treatment. Immunomodulatory drugs such as azathioprine are usually used when, AIP patients have no response to steroid management, relapse occurs and patients cannot be weaned off steroids.

Medical Therapy

Role of Glucocorticoids:

  • Preferred regimen: Prednisone is usually administered at an initial dose of 40 mg/d for 4 weeks followed by a taper of the daily dosage by 5 mg/wk depending upon the clinical parameters.
  • Glucocorticoids are found to play an important role in the management of autoimmune pancreatitis via several ways such as:[1][2][3][4]
    • Efficacy in alleviating symptoms.
    • Decreasing the size of the pancreas.
    • Reversing histopathologic features in patients with AIP.
    • Improvement of lab findings such as:[5]
Response to Glucocorticoids:
  • About 2/3rd of patients show good response to glucocorticoids with complete recovery.[6][7][8]
  • Approximately 25% may require a second course of glucocorticoids.
  • A few patients with autoimmune pancreatitis may require continuous treatment.

Response to Glucocorticoids in patients with Biliary strictures:

Patients with biliary strictures have a variable response to glucocorticoids such as:[6][8][9][10][11]

Monitoring of clinical parameters in patients on glucocorticoid therapy:

Glucocorticoids are tapered depending upon following clinical parameters:[2][3][12][13]

  • Relief of symptoms.
  • Serial changes in abdominal imaging of the pancreas and bile ducts.
  • Decreased serum γ-globulin and IgG4 levels.
  • Improvements in liver function tests.

Role of Immunomodulatory drugs:

Immunomodulatory drugs such as azathioprine are usually used when:

  • AIP patients have no response to steroid management.
  • AIP patients relapse, if steroids are discontinued.
  • AIP patients cannot be weaned off steroids.

The monoclonal antibody, Rituximab, is found to be effective in the management of AIP but further studies are required for the recommendation of routine use.[14][15][16]

References

  1. ↑ Kamisawa T, Egawa N, Nakajima H, Tsuruta K, Okamoto A, Kamata N (2003). "Clinical difficulties in the differentiation of autoimmune pancreatitis and pancreatic carcinoma". Am. J. Gastroenterol. 98 (12): 2694–9. doi:10.1111/j.1572-0241.2003.08775.x. PMID 14687819.
  2. ↑ 2.0 2.1 Hirano K, Tada M, Isayama H, Yagioka H, Sasaki T, Kogure H, Nakai Y, Sasahira N, Tsujino T, Yoshida H, Kawabe T, Omata M (2007). "Long-term prognosis of autoimmune pancreatitis with and without corticosteroid treatment". Gut. 56 (12): 1719–24. doi:10.1136/gut.2006.115246. PMC 2095691. PMID 17525092.
  3. ↑ 3.0 3.1 Moon SH, Kim MH, Park DH, Hwang CY, Park SJ, Lee SS, Seo DW, Lee SK (2008). "Is a 2-week steroid trial after initial negative investigation for malignancy useful in differentiating autoimmune pancreatitis from pancreatic cancer? A prospective outcome study". Gut. 57 (12): 1704–12. doi:10.1136/gut.2008.150979. PMID 18583399.
  4. ↑ Ito T, Nakano I, Koyanagi S, Miyahara T, Migita Y, Ogoshi K, Sakai H, Matsunaga S, Yasuda O, Sumii T, Nawata H (1997). "Autoimmune pancreatitis as a new clinical entity. Three cases of autoimmune pancreatitis with effective steroid therapy". Dig. Dis. Sci. 42 (7): 1458–68. PMID 9246047.
  5. ↑ Hamano H, Kawa S, Horiuchi A, Unno H, Furuya N, Akamatsu T, Fukushima M, Nikaido T, Nakayama K, Usuda N, Kiyosawa K (2001). "High serum IgG4 concentrations in patients with sclerosing pancreatitis". N. Engl. J. Med. 344 (10): 732–8. doi:10.1056/NEJM200103083441005. PMID 11236777.
  6. ↑ 6.0 6.1 Ghazale A, Chari ST, Zhang L, Smyrk TC, Takahashi N, Levy MJ, Topazian MD, Clain JE, Pearson RK, Petersen BT, Vege SS, Lindor K, Farnell MB (2008). "Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy". Gastroenterology. 134 (3): 706–15. doi:10.1053/j.gastro.2007.12.009. PMID 18222442.
  7. ↑ Raina A, Yadav D, Krasinskas AM, McGrath KM, Khalid A, Sanders M, Whitcomb DC, Slivka A (2009). "Evaluation and management of autoimmune pancreatitis: experience at a large US center". Am. J. Gastroenterol. 104 (9): 2295–306. doi:10.1038/ajg.2009.325. PMID 19532132.
  8. ↑ 8.0 8.1 Sandanayake NS, Church NI, Chapman MH, Johnson GJ, Dhar DK, Amin Z, Deheragoda MG, Novelli M, Winstanley A, Rodriguez-Justo M, Hatfield AR, Pereira SP, Webster GJ (2009). "Presentation and management of post-treatment relapse in autoimmune pancreatitis/immunoglobulin G4-associated cholangitis". Clin. Gastroenterol. Hepatol. 7 (10): 1089–96. doi:10.1016/j.cgh.2009.03.021. PMID 19345283.
  9. ↑ Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, Zhang L, Clain JE, Pearson RK, Petersen BT, Vege SS, Farnell MB (2006). "Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience". Clin. Gastroenterol. Hepatol. 4 (8): 1010–6, quiz 934. doi:10.1016/j.cgh.2006.05.017. PMID 16843735.
  10. ↑ Kamisawa T, Egawa N, Nakajima H, Tsuruta K, Okamoto A (2004). "Morphological changes after steroid therapy in autoimmune pancreatitis". Scand. J. Gastroenterol. 39 (11): 1154–8. doi:10.1080/00365520410008033. PMID 15545176.
  11. ↑ Wakabayashi T, Kawaura Y, Satomura Y, Watanabe H, Motoo Y, Sawabu N (2005). "Long-term prognosis of duct-narrowing chronic pancreatitis: strategy for steroid treatment". Pancreas. 30 (1): 31–9. PMID 15632697.
  12. ↑ Maire F, Le Baleur Y, Rebours V, Vullierme MP, Couvelard A, Voitot H, Sauvanet A, Hentic O, Lévy P, Ruszniewski P, Hammel P (2011). "Outcome of patients with type 1 or 2 autoimmune pancreatitis". Am. J. Gastroenterol. 106 (1): 151–6. doi:10.1038/ajg.2010.314. PMID 20736934.
  13. ↑ Sahani DV, Sainani NI, Deshpande V, Shaikh MS, Frinkelberg DL, Fernandez-del Castillo C (2009). "Autoimmune pancreatitis: disease evolution, staging, response assessment, and CT features that predict response to corticosteroid therapy". Radiology. 250 (1): 118–29. doi:10.1148/radiol.2493080279. PMID 19017924.
  14. ↑ Hart PA, Topazian MD, Witzig TE, Clain JE, Gleeson FC, Klebig RR, Levy MJ, Pearson RK, Petersen BT, Smyrk TC, Sugumar A, Takahashi N, Vege SS, Chari ST (2013). "Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab: the Mayo Clinic experience". Gut. 62 (11): 1607–15. doi:10.1136/gutjnl-2012-302886. PMID 22936672.
  15. ↑ Topazian M, Witzig TE, Smyrk TC, Pulido JS, Levy MJ, Kamath PS, Chari ST (2008). "Rituximab therapy for refractory biliary strictures in immunoglobulin G4-associated cholangitis". Clin. Gastroenterol. Hepatol. 6 (3): 364–6. doi:10.1016/j.cgh.2007.12.020. PMID 18328441.
  16. ↑ Rueda JC, Duarte-Rey C, Casas N (2009). "Successful treatment of relapsing autoimmune pancreatitis in primary Sjögren's syndrome with rituximab: report of a case and review of the literature". Rheumatol. Int. 29 (12): 1481–5. doi:10.1007/s00296-009-0843-5. PMID 19137434.

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