Téma: Overview works

The obstacles in diagnosis of autoimmune pancreatitis

Vladimír Klinovský, Marian Bátovský

This article discusses the various diagnostic possibilities of autoimmune pancreatitis. Diagnostic criteria used in leading centers are based largely on a combination of several methodologies, as each methodology has a relatively significant limitations. For imaging methodologies we find difficulty in defining the very terms used, we can also observe the contradiction of CT and ERCP findings in terms of their classical interpretations. Most beneficial imaging methodology, ERCP, usually due to absence of dilatation of the pancreatic and bile ducts is rarely indicated and is associated with technical difficulties of obtaining adequate pancreatogram. MRCP in the case of AIP can not replace ERCP. Laboratory diagnosis was initially based on confirmation of an autoimmune process involving elevated levels of IgG and hypergammaglobulinemia, and later on associations with certain autoantibodies, while those with the highest specificity are not available with common laboratory equipment. An important finding was that higher levels of IgG4 or immune complexes distinguish AIP from other pancreatic diseases with high sensitivity and specificity, although IgG4 still remains nonspecific marker of AIP. Lymphoplasmacytic infiltration may be minimal, and later becomes more dominant fibrosis, moreover, this infiltration is not only typical for AIP. In some cases, AIP is dominated by neutrophilic and eosinophilic infiltrate associated with destruction of ductal epithelium. It is also very difficult to obtain biopsy. Patchy changes in AIP, as well as the risk of iatrogenic seeding of the pancreatic cancer favors endoscopic ultrasonogram-guided biopsy. AIP requires further research that would provide more effective methods of diagnosis of the disease as well as lighting of other aspects.

Ročník 2010  Témy časopisu Gastroenterology for practice 4 / 2010

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